Blood Brothers
by ggo85
Summary: Doc Martin is called upon to help out a friend, creating unexpected complications for both.
1. Chapter 1

**Rating: PG (very mild adult themes)**

**Setting: The story begins around the time of S5, episode 4.**

**Disclaimer: The story and characters of Doc Martin belong to Buffalo Pictures. This work of fanfiction is for personal amusement only and no infringement of any legal rights is intended.**

**Author's Notes:**

**For reasons that will become evident, this story involves a fair amount of "medicalese." Where necessary, there's a medical glossary at the end of the chapter.**

**A huge thank you to my beta jd517. Her insightful comments helped me over the rough patches and definitely made the story better. Any errors that remain are due to my inability to stop tinkering.**

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><p>Dinner parties ranked high on my list of events to avoid. First, I had no control over the type or quality of food being served or the time it would be served, which was invariably later than I preferred. And, the idea of spending several hours within the confines of another person's home being forced to converse about absolutely nothing of significance or, worse, to talk about myself, was absolutely abhorrent.<p>

Thankfully, after several years in Portwenn, such invitations issued to me had become few and far between. However, unlike me, Louisa enjoyed the company of others and thus, I'd come to learn, was frequently invited to meals with the local denizens. Including me in those invitations was now apparently a necessity because Louisa and I were sharing a home. It was, in my opinion, an unfortunate development.

Having an infant son provided the perfect excuse to turn down those dinners we didn't want to attend which, for me, was virtually all of them. I much preferred to spend my evening eating a quiet meal with Louisa and the baby. That was enough of a transition from my many years of solitary dining.

This evening's dinner invitation from Chris Parsons differed from most in two important ways. First, Parsons and his wife Emily were among the rare birds who actually wanted to see me as well as Louisa. And, second, Parsons was probably the only person other than Louisa with whom I might actually enjoy having a meal. Still, I'd demurred.

"Come on, Martin," Parsons insisted when he'd issued the invitation over the phone earlier in the week. "Emily's counting on you coming. She hasn't seen you in months," he added.

"I don't know. Louisa's been so tired of late." Taking care of an infant was more exhausting than either of us had fully anticipated and, with me temporarily resuming my role as GP, she bore the brunt of our son's care and feeding.

"Consider it a date night," Parsons replied.

"A what?"

"Date night. What you and Louisa did on Saturday nights before the baby came along," he explained.

I paused, trying to remember our "dates." Other than the concert, which hadn't gone at all well, and the subsequent evening at the Large restaurant that was interrupted by the postman's attack of pulmonary aspergillosis . . . I really couldn't think of any outings with Louisa that met his description.

"We, ah, didn't date," I said. "Exactly."

"No matter. This can be a date."

I frowned into my mobile. "Right."

"Oh, Mart. Just come. Emily and I would love to see the two of you and it will do you good to get out for a night."

Of course Louisa had wanted to go. So, we'd left the baby in the care of a sitter. I didn't know the woman, but Louisa had assured me she came highly recommended. We'd left her with explicit instructions to call us if there were any problems at all – and made the hour-long drive to the outskirts of Truro.

I'd been to Parsons' home on numerous occasions over the years. It was several times the size of mine in Portwenn – large, if unpretentious. I wasn't much for décor but it all seemed tasteful and Louisa, who was visiting for the first time, seemed to find everything "lovely," or "wonderful."

At one point during the tour of the main floor, Louisa prodded me for a comment about some piece of upholstered furniture.

"It seems . . . functional," was the best I could manage.

The pre-dinner conversation went surprising well, at least as far as I could tell, probably because Louisa was doing most of the talking. She, Parsons and I were in the sitting room; Emily had retired to the kitchen to finish the dinner preparations.

"Louisa, I still can't get over that you delivered your baby in a pub," Parsons was saying with a smile. "That will certainly give you a tale to tell for years."

"I'm sure it will," Louisa said. "At least Martin was able to be there when the baby was born."

She and Parsons both knew that, had not the taxi driver and his wife foolishly tried to make their own petrol, I would have been halfway to London and Louisa would have delivered our child alone, something that, at the time, I'd been perfectly prepared to let her do.

Louisa twisted toward me on the sofa and laid her hand on my knee, sending tingles up and down my leg. She was pressed into my side. Her closeness, the warmth of her body, the scent of her lavender soap . . . I forced my mind to return to the conversation at hand.

"So you're definitely going back to your job as head teacher?" Parsons asked Louisa.

"Yes. I'm scheduled to start back in another two weeks."

I forced myself not to scowl. The subject of her quick return to work remained a sore point between us. She was completely exhausted simply caring for the baby. I couldn't imagine how she could possibly continue to do that and work full-time as head teacher, even for the few weeks before we left for London.

Parsons leaned forward in his chair. "You know that Emily went back to work after Danny was born."

"Really?" Louisa said, giving me a look of triumph.

I had some recollection that Emily had been a social worker but also knew that, as some point, she'd stopped working to stay at home with their son, which proved my point. "It didn't last long though, did it?" I asked, earning a disapproving look from Louisa.

"Lasted for quite a few years," Parsons replied evenly. "And I know Emily enjoyed the intellectual stimulation. Much as she loved taking care of Danny, talking only to an infant all day can be a bit rough."

"When did she decide to become a full-time mum?" Louisa asked.

"Once Danny started getting involved in all his school activities and I took the position with the PCT, it was hard for either of us to drive him back and forth, let alone actually be there for his athletics and things."

"How old is Dan now?" I asked politely, not quite remembering. "Ten?"

"Nearly eleven. Hard to believe, isn't it?"

"No," I said succinctly. "He appears to be the right height and weight and appropriately developed for a boy of that age."

Louisa gave me an exasperated look and rose to her feet. "I'll just help Emily with dinner."

Parsons waved her back into her seat. "No, you stay put. You're here to relax."

"It's all right. Besides," she said with a smile, "I'm sure she can give me some tips on being a working mum."

I'd never understood the propensity of women to congregate together – at parties, in kitchens, in lavatories. Whatever did they talk about?

The moment Louisa left the room, Parsons turned to me. "I'm glad you decided to stay in Portwenn, Martin. Really helped me out of a bind."

"Yes, well, you know it's not permanent."

Parsons' eyebrows lifted. "I'd hoped you might change your mind and decide to stay with us."

"No. I'm meant to be a surgeon, and I intend to be just that."

"Well, you know I'll support you in whatever you decide to do."

That much was true. Over the years, Parsons had been more of a friend than I probably deserved. He'd managed to get me the GP position in Portwenn when few other PCTs probably would have taken me and then, when I'd decided to return to surgery, he was the one who'd first interceded with Imperial Hospital.

"In any event," Parsons continued, "I know I invited you for a social visit but I wondered if, while Louisa's with Emily, we might talk a little business."

Inwardly I groaned. Chances were that yet another patient had lodged a complaint about me with the PCT. By now I'd heard them all – I was obnoxious, mean, abrupt, nasty, sarcastic, dismissive, and dozens more adjectives, some of which might well be accurate, at times. What I didn't understand was why my patients didn't seem to care about the more important qualities of a GP, such as competence.

I knew all of my patients weren't thrilled to have me back as their GP, but after that well-intentioned but hardly confidence inspiring Dr. Dibbs, I would have thought they would have at least been quiet for a few days.

"Now who's complaining?" I asked, more out of habit than interest.

"Complaining?" Parsons actually looked surprised.

"About me," I clarified.

"No one that I know of."

Well, that was a relief of sorts. I gave Parsons an expectant look.

"I wanted to consult with you about a patient," he said.

I frowned. "Me? Surely there's at least one capable GP in Truro."

"But none trained as a vascular surgeon."

My eyebrows lifted at the comment. Interesting. And whatever Parsons' reasons for consulting me, I'd rather discuss medicine than talk about myself or life with a newborn baby. I leaned forward in my chair even as Parsons slouched back in his. "Tell me about the patient," I said.

"Forty-six year-old white male, non-smoker, slightly overweight. History of hypertension and elevated cholesterol, both controlled with medication, but no history of vascular disease. Complains of an incident of short-term neurological deficit."

Yes, it could well be a vascular problem. The symptoms could also be due to a neurological condition or at least a dozen other causes. I'd need to know more before I could offer any meaningful diagnosis.

"What type of neurological deficit?" I asked.

"Blurred vision, aphasia, hemiparesis."

That could well be serious. Or not. "Any recent trauma?"

"No."

That ruled out a few things. "Does your patient have a history of—"

Parsons took off his glasses and rubbed his eyes. "Oh, hell, Martin. I'm the patient."

"What?" I blinked several times and felt my jaw drop.

"I've been experiencing symptoms that I think might be – never mind, I want _your_ opinion."

I closed my open mouth. "Slow down." I was still trying to get my head around what Parsons had just told me. The symptoms he was describing didn't belong to some unknown patient; they belonged to him – a man I'd known for more than two decades. Subconsciously I switched into professional mode and immediately started a visual examination. "Start at the beginning."

"Which is?"

Good point. "What are your symptoms? And be precise."

Parsons smiled and held out his open palms. "At the moment, I feel perfectly fine."

I snorted a bit at his quibbling. "So you've _had_ symptoms?"

"Once, about a fortnight ago. I was watching the telly and, without warning, I suddenly—"

There was a noise from the doorway. Parsons closed his mouth and glanced up as Louisa stepped into the room.

The first thing that crossed my mind was annoyance that she was interrupting our conversation; her appearance at this moment was inopportune at best.

"Supper's almost ready," she said in a cheerful tone that made clear she didn't realize she'd intruded into a critical discussion. She gave Parsons a broad smile. "I think Emily could use your help carving the roast."

"Not now," I snapped. Blast the stupid dinner; Parsons' health was much more important.

Parsons stood up. "It's all right, Mart. We can talk about this later."

"We need to talk about it now—"

"Later." He gave me a look that said that, no matter how hard I pressed him, the subject was closed for the moment and probably the entire evening.

Louisa glanced between us in confusion and I sighed loudly.

"Best go assist my lovely bride," Parsons said. "I know how you like to eat early, Mart."

I frowned again but let him leave, only because I didn't have much choice. The whole situation frustrated me immensely. Any neurological symptoms needed to be evaluated; as a doctor, Parsons knew that as well as I did. I bit my lower lip and seethed.

"Everything all right?" Louisa asked.

My eyes followed Parsons out the door. "Yeah," I lied.

Louisa sat down beside me and began stroking my leg, oblivious to my consternation. "It's a lovely evening, isn't it?"

"Um, yes. It is." Whereas earlier, I'd taken pleasure in her touch, now I found it almost irritating. I found myself mentally reviewing what little Parsons had told me and didn't want to be distracted from my clinical thoughts, even by Louisa.

"It's so kind of Emily and Chris to have us over."

"Uh-huh." As was so often the case, she'd misread my hesitation for nervousness and felt the need to continue talking. Sometimes when we were together, she just didn't understand that my focus needed to be on something or someone other than her.

"Chris is such a nice man," she continued. "How did the two of you become mates?"

I wasn't sure "mate" was the right word to describe my relationship with Parsons. Then again, he _was_ probably the closest I had to an actual friend.

"We were partners in anatomy class," I said, absently. My mind kept flicking back to the symptoms he'd described. The possible causes were endless and some quite serious. Damn him for ending our conversation before I could probe further. "We had the same cadaver for dissection."

"You met over a dead body. How . . . interesting."

"One day after class, he invited me out for a pint."

"And you went with him?"

"Of course not." I snorted defiantly. "You know I don't drink alcohol."

"But you could have at least joined him—"

"I didn't." I looked away. "We really didn't get on those first few years."

This conversation was becoming interminable and it was all I could do to contain my impatience. Even though, at the moment, there wasn't anything I could do for Parsons, once dinner was over would be a different story entirely – I'd force the man to describe his symptoms if I had to wait the entire evening. I swallowed a deep breath and tried to focus my attention on Louisa.

She turned to me. "You didn't get along? What changed then?"

I let out a deep breath, thinking back. "We were on the wards together as junior house officers. One night, Parsons had a patient who was quite ill. Young girl – he couldn't figure out what was wrong. He'd ordered all the right tests, given the proper medications, and yet she was getting worse. Out of desperation, he came to me."

"And you figured it out."

"We both did. We spent I don't know how many hours in the middle of the night, both of us exhausted, re-examining the patient, going through each word of her medical history, and reanalyzing every test result until we came up with the answer."

Years later, I still remembered the night well. I'd always been a loner in medical school. Whereas most of my classmates clustered in study groups and tested each other with ridiculous flashcards, I'd been able to excel academically on my own. And I was never one for the parties that some of my socially-oriented classmates organized. I'd always been satisfied working on my own; I never needed anyone else. So, the idea that one of my classmates might want – or even need – my professional opinion had never really occurred to me.

What surprised me most when Parsons consulted me was _his_ intellect. I was certain that, within minutes, I would identify the symptom he obviously must have missed; I would quickly point out his ineptitude. Instead, I found that he had done absolutely everything I would have done and done it exceedingly well. As we put our heads together that night, I realized for the first time that it was actually more satisfying to tackle a problem with a bright colleague than to do it alone. And, that I actually enjoyed Parsons' company.

"So what happened?" Louisa asked, bringing me back to the present.

I shrugged. "The girl had an intestinal infection. She had surgery and made a full recovery."

"And thus was the start of a beautiful friendship," Louisa exclaimed dramatically.

"The start of mutual respect," I clarified.

"But you did become friends."

"Yes, I suppose we did."

"And you've remained friends all these years—"

We both jerked around at the sound of a large crash from the kitchen.

"Chris! My salad!" Emily's tone was a mixture of dismay and reproof.

Louisa and I exchanged somewhat bemused glances. It was obvious to both of us that Parsons had dropped part of this evening's dinner and that the hostess was displeased at the turn of events.

Louisa rose from the sofa. "Oh dear! Maybe I can help clean up."

A few seconds later, Emily called out Chris's name again only this time there was something in her voice that ignited my professional instincts. I didn't have to strain my ears because the next thing I heard was a shout.

"Oh God. Martin! Get in here! Quickly!

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><p>Medical Glossary (I'm not a medical professional; the explanations are for ease of reading only)<p>

Aphasia – impairment of language ability; trouble speaking normally

Hemiparesis – paralysis on one side of the body


	2. Chapter 2

The first thing I noticed as I rushed into the kitchen was a pile of lettuce, tomatoes, cucumbers and other chopped vegetables littered across the floor near an upturned wooden bowl. I stepped around the mess and hurried over to Parsons, who was slouched awkwardly in one of the kitchen chairs. Emily, who'd been standing over him, quickly moved aside.

"What's wrong?" I asked, steadying his head in my hands and peering into his eyes, which were unfocused and terrified.

He grabbed at the sleeve of my suit with his left hand. "Mwwtt," he garbled, only the left side of his mouth moving.

Trouble speaking. Aphasia, he'd told me was one of his previous symptoms. Or was it paralysis? Either had appeared virtually instantaneously as Parsons' speech had been perfectly normal not a few minutes before. I turned to Emily. "What happened?"

She was clearly flustered. "I don't know! I asked Chris to take the salad into the dining room and, the next thing I knew, the salad was on the floor and he couldn't stand up. I only just managed to get him into the chair." She was twisting one hand on the other, eyes fresh with worry. "Martin, what's wrong with him?"

"I don't know yet," I replied, unable to keep the sharpness out of my tone. How was I supposed to diagnose him within thirty seconds without any medical equipment? I again looked at Parsons, focusing my full attention on his symptoms. A neurological problem was the most likely explanation, but others came to mind as part of my mental differential.

I grabbed his shoulders. "Chris, can you hear me?"

He opened his mouth and once again only gibberish came out.

"Don't try to speak for now." I reached into the pocket of my suit jacket for my penlight. Blast! Of course I hadn't bothered to bring it on a social visit. I glanced around for Louisa, who hovered in the doorway, staring at us with an expression that indicated she was clearly vexed at the turn of events.

I pulled my car keys out of my trousers pocket and handed them to her. "Get my medical bag."

"Should I call an ambulance?" Emily asked.

"Not yet," I replied absently, turning my attention back to Parsons. A check of his pulse found it elevated, but not dangerously so and his breathing was normal. "Are you having pain anywhere?"

"Carry drop salad."

I frowned at the response. "Are you in any pain?" I repeated.

"Move not arm."

Broca's aphasia, I told myself, mentally reviewing the potential causes of the condition. I was beginning to consider whether Parsons was having a CVA. His age mitigated against it, as did the lack of severity of his symptoms. Still, it was a possibility I'd have to rule out.

"What's wrong with my dad?" came a child's voice from the kitchen doorway. Parsons' son was now standing there, staring at his father, horror etched on his features. At the same moment, Louisa appeared beside him, medical bag in hand.

"It's all right, Danny," she said, touching a hand to his shoulder. "Your dad's going to be fine."

"You don't know that," I snapped, impatiently reaching for my bag.

"Martin!" She handed me the case, then put her arm protectively around the boy. "Dr. Ellingham's going to take good care of your father, aren't you Martin?"

"Yes," I replied impatiently.

"Come on, Danny, let's leave him to do his job."

"I want to stay with my dad."

And I wanted to get the whole lot out of the kitchen so I could examine Parsons without an audience. I'd no doubt that the sight of his wife and child gawking at him wasn't improving his condition.

"Come on Danny," Louisa repeated, gently pulling him away from the scene. "Emily, why don't you join us?" It was as if she'd read my mind and, when she glanced back at me, I realized she essentially had.

I threw Louisa a grateful look as she left the room and, pulling up a chair next to Parsons, checked his pupils, which were equal and reactive. His BP at 156/92 was on the high side. I took each of his hands in my own.

"Chris, squeeze my hands." Nothing. "Come on. I need you to squeeze my hands." After a few seconds, I felt a slight pressure from his left hand being held in my right. "Harder!" The pressure increased slightly on the left side. Parsons' right hand rested limply in mine, and his eyes remained filled with fear.

"It's all right. Rest a moment."

I leaned back in the chair and assessed what I knew. Parsons was in no immediate danger but equally obviously had experienced an attack of some sort that had left him with aphasia, confusion, and right side muscle weakness. The problem could be neurological, vascular or even viral, and multiple differential diagnoses came to mind. To confirm any of them would require an investigation and testing beyond what I could perform here. In the meantime, there was little I could do for Parsons medically other than monitor his condition. If it didn't improve, I'd have to call for an ambulance and admit him to hospital.

I repacked my bag and considered whether I could leave him alone long enough to update Emily on his condition.

"Mart?" He blinked rapidly then looked down at his hands, trying to wiggle his fingers.

I let loose a tight breath. The fact he recognized me and had spoken a clear word was a good sign. "Chris?"

His eyes focused on mine. "What happened?" he asked.

I gazed steadily at him. "You tell me."

"Carry salad and hand . . . not feel. Not stand up. Emily . . ." His eyes looked around wildly. "Where's Emily?"

"Sitting room."

Parsons was still experiencing some aphasia. I again grabbed his hands. "Squeeze my hands as tightly as you can." This time, he responded immediately to my command, and I was pleased that his strength was almost equal bilaterally. I watched carefully as he took some deep breaths and tested his right arm and leg. A check of my watch showed that less than twenty minutes had elapsed since I'd been summoned to the kitchen.

"Mart?" Parsons asked me quizzically. "What . . .?"

There were quite a few possibilities. The rapidity of onset and short-term resolution of symptoms narrowed the potential options. Although a CVA was off the list, there were still quite a few serious conditions that could present with the symptoms Parsons had experienced – brain tumor, Guillain-Barre, and MS among them. Based on my experience, another possibility seemed more likely.

"I think you may have just suffered at TIA," I said.

"I'm all right," Parsons said after a moment, making as if to get up. "Tell Emily okay. Scary."

I pushed him back into the chair. Until the aphasia fully passed, his talking to Emily would only frighten her more than she already was. "Rest here awhile longer. I'll go speak to her."

After quickly assuring Emily that her husband was stable for the moment and was starting to recover, I returned to my supervisor, friend, colleague, and – for the moment – patient. He looked better, stronger, and more confident than when I'd left the room only a few minutes before. In fact, had I not witnessed his attack, I would have never have believed that, less than a half hour ago, he could barely speak or move.

"I should admit you to hospital tonight," I said, more to gauge Parsons' reaction than because I had any real intention of doing so.

Parsons shook his head. "No."

It was the reply I'd expected and, in fairness, there was nothing that the hospital could do this evening that his GP couldn't do equally well the next day. "You need to see your GP straight away."

He again shook his head and pointed his finger at me. "You."

"What about me?"

"I want you to examine me."

My eyes narrowed. "Me? Why?"

He gave me a slight smile. "You're the best GP I know."

"Chris, I don't think—" It was a nice compliment and probably true. But Parsons must have a regular GP, and it made more sense for him to consult a physician familiar with his medical history.

"I don't need the entire PCT gossiping about me," Parsons added, and I recalled the words of Mark Mylow so long ago – "I'm known there." It was true of Parsons as well.

I noted that, in the short time I'd been out of the room talking to Emily, Parsons' aphasia had disappeared almost as quickly as it had come on.

"Will you help me?" Parsons asked.

"Of course I'm going to help you. I'm going to refer you to Nigel Leahy or Brent Meadows who can get you on the damned table where you probably belong." I was furious. Furious that he'd ignored what were potentially serious symptoms and furious that, rather than visit an actual vascular surgeon or even his GP straight away he'd instead come to me weeks after the initial episode.

"Martin, we don't even know what's wrong with me. I'm no vascular specialist. Maybe it's a neurological problem. Which is why I'm asking you as a colleague and a friend to figure out what's wrong with me. That's all."

I rubbed the bridge of my nose. What Parsons was asking wasn't technically difficult. I could still do a vascular workup in my sleep. It was the patient who was the problem. The reason I was here as a GP rather than in an operating theatre in London, was that I couldn't deal with the fact that my patient was a real human being and not just a vein or artery that needed repair.

I shook my head to clear the memories and sat up straight. I was the one being an idiot. Maybe Parsons was wrong about his symptoms. He was an endocrinologist who'd spent the past few years doing mostly administrative work – he wasn't a vascular surgeon, neurologist, or even a GP. Maybe he didn't have vascular disease or, in any event, didn't need surgery. It wouldn't kill me to work him up and it might well kill him if I sent him elsewhere where some incompetent might well misdiagnose him. After all that Parsons had done for me over the years, I could spare an hour helping him.

"All right. Be in my surgery first thing in the morning."

"It's Sunday."

"I know what day it is. Just be there."

Before I left, I rechecked Parsons, whose symptoms appeared to have completely resolved. It was as if the attack earlier in the evening had never occurred. I arranged for him to meet me in the surgery early the next morning and extracted a promise from Emily to drive him there, as I wouldn't risk a return of his symptoms while he was behind the wheel of a car.

"If he has another attack tonight, call 9-9-9 immediately," I ordered. Parsons gave me a foul look but Emily nodded her agreement.

Shortly thereafter Louisa and I took our leave, dinner sitting cold in the kitchen. The incident with Parsons had destroyed our appetites and I was more interested in him getting to bed than continuing to host a dinner that none of us now wanted to eat.

"What happened to Chris?" Louisa asked me in the car on the way home. "It was so frightening when he couldn't move or speak. And then he seemed fine when we left."

I considered how much to tell her. Patient confidentiality had to be balanced against the fact that Louisa had observed the entire incident and was naturally concerned about Parsons' health. And, now that we were living together, she was bound to become privy to some of my patients' medical problems.

"I think he may have suffered a transient ischemic attack," I finally replied. "It's somewhat like a small stroke." Technically, it was no such thing but it was the easiest way to describe the condition to a layperson.

"It's serious then?" she asked.

"Could be."

"Oh dear. Can you help him?"

"Probably, but first, I need to figure out what's wrong. A TIA – what I think happened to him tonight – is only a symptom. An underlying condition is the cause."

"Well, it's good that he has you to diagnose him. I know Emily was thankful you were there tonight."

"It was good of you to get her out of the room while I examined him."

My comment was met with a brief smile from Louisa. "Emily handled the whole episode quite well, didn't she?"

"Ah, yes, I suppose so." It was true that the woman hadn't become hysterical and, more importantly, had agreed to do what I'd asked. Even so, my mind wasn't on this conversation. I was already considering the examination I would perform, the tests I would order, and – with a heavy heart – what I might find.

* * *

><p>Medical Glossary<p>

Aphasia – impairment of language ability; trouble speaking normally

Broca's aphasia – a specific type of aphasia where speech is difficult to initiate, non-fluent, labored and halting. Language is reduced to disjointed words and sentence construction is poor, omitting words and inflections.

CVA – cerebral vascular accident – a stroke

Differential/differential diagnosis – the way doctors arrive at a diagnosis by eliminating potential causes until the most likely cause(s) remains

Endocrinologist – doctor who specializes in parts of the body related to hormones, and the endocrine glands and tissues that secrete them. Endocrinologists often deal with diabetes, for example.

Guillain-Barre Syndrome – an acute neurological disorder affecting the peripheral nervous system

MS – Multiple sclerosis


	3. Chapter 3

I greeted Chris and Emily Parsons at the door to my surgery shortly before 0900. Given that it was a Sunday, my receptionist was absent and the waiting room deserted. It had been raining steadily since before dawn and my two visitors quickly closed up their umbrellas and deposited them in the stand by the door.

"Morning, Mart," Parsons said, stripping off his MacIntosh, shaking off the water, and then laying it carefully over the back of one of my chairs. He was dressed casually in a shirt, pullover and trousers, and wore glasses rather than the contacts he sometimes favored.

As he and Emily stood side-by-side, I was reminded that she was a head shorter than her husband. Like him, she was somewhat on the plump side, though hardly obese, and unlike Parsons, had a full head of curly reddish-brown hair. I couldn't help but think that they looked like they belonged together, something few people probably would say about Louisa and me.

"Any lingering problems last night?" I asked.

"No," Parsons replied. "Slept like a baby."

_Our_ baby had been up twice during the night, and I hoped Parsons had slept better than I had. I looked at Emily for confirmation. "No problems," she said, with a forced smile that didn't quite hide her worry.

"Good," I said, and saw Emily frown. She undoubtedly was hoping I would say something reassuring. However, until I'd completed my examination I wasn't prepared to give her false hope.

Instead, I grabbed a fresh card for patient notes. "Should I have you register with the practice first?" I asked, my eyes at least attempting a smile. "I wouldn't want to be accused of not following proper procedures."

"You'll be okay." Parsons' eyes nervously twinkled back at me. "I'll put in a good word for you with the head of the PCT."

I was relieved that Parsons seemed back to his normal self. Nonetheless, last night's events couldn't be ignored. It was time to get started. The exam could take some time and there wasn't much for Emily to do in my waiting room. Normally, she could visit with Louisa, but as she'd been sleeping when I'd come downstairs, I suggested Emily try the coffee shop down the street and sent Parsons through to my consulting room.

"How are Louisa and the baby?" he asked, once he'd seated himself in front of my desk.

"They're fine." This wasn't the time for small talk. I picked up my pen. "Shall we get started?"

"Sure."

Given that I didn't have his GP's notes, for the next ten minutes I methodically went over his medical history, starting with childhood illnesses and working my way to the present. If Parsons was annoyed with my thoroughness, he tolerated it well and answered my questions without complaint.

"Last night you mentioned a history of hypertension," I said. "How long?"

"Ten years. It started after my mum and dad died in the same year."

I glanced up in surprise. "Hmm." I probably should have said that I was sorry, but I hadn't known his parents nor that they'd died. And I couldn't help but think that my own blood pressure would likely have gone down with news of my parents' deaths.

"What medications are you currently taking for it?"

Parsons easily rattled off the names and dosage amounts and assured me that the hypertension was under control. There were benefits to having a physician as a patient.

I glanced back down at my notes. "You said your cholesterol was elevated."

"I'm on Lipitor. My medicine cabinet looks like a damn pharmacy."

"Last night you started to tell me about a prior episode of neurological deficit. Aphasia, hemiparesis, paresthesia," I reminded him.

"Right." Parsons cleared his throat. "As I was saying last night, about a fortnight ago I was home watching the telly; Emily and Dan were at school. All of a sudden, my vision got blurry and the right side of my body went numb. It was as if I couldn't even think straight."

Parsons had detailed his symptoms more as a patient than a physician – not exactly a precise medical description, I noted in passing. "What did your GP say?"

"I didn't go see her."

I'd come to expect most of my patients to act like imbeciles, but not Chris Parsons. He of all people should know better.

"You're an idiot," I said sharply. "You had a significant neurological incident and, instead of consulting your GP straight away, you sat around for a fortnight until you had another attack. Just brilliant."

"Come on, Mart. I wasn't even sure it was serious."

"Oh, that's ripe. Did you think your symptoms were normal?"

He gave me a weak smile, which I didn't return. "No wonder your patients complain about you."

"Only the stupid ones." I said, shaking my head. "Describe the numbness."

"At first it felt like my arm and leg had fallen asleep. But when I tried to move them, I couldn't. I thought I might be having a CVA."

"And yet you didn't think to consult a physician."

"I _am_ a physician and I did consult you. Besides, the symptoms resolved almost immediately."

"Right." I drew out the word to emphasize my displeasure with the way he'd handled the situation.

"Dammit, Mart, I'm here now, aren't I?"

Although berating Parsons might make me feel better, it wouldn't help me address his symptoms. I forced myself to keep my irritation at least somewhat in check. "How long did the prior episode last?"

"Five minutes at most."

"And did you recover fully?"

"Yes. By the time Emily got home, it was as if nothing had happened."

But something clearly had happened and two such incidents in such a short time were ominous. I continued on, forcing him to relate details of each symptom. Only when I was convinced there was nothing left to learn by further questioning, I looked up from my notes.

"When's the last time you had a complete medical examination?"

"Couple of years ago."

My eyes narrowed. "How many is 'a couple'?"

Parsons gave me a sheepish look. "Three, maybe four."

"Oh, for God's sake." I shook my head in disgust as I stood up from the chair and walked over to the bank of cabinets against the wall. How could Parsons be so cavalier about this? I could only hope his stupidity and delay hadn't adversely affected his health.

In my prior life as a surgeon, I would simply have done what the referring GP had requested – an exam to confirm or rule out a vascular etiology. That, of course, presupposed that Parsons had already been seen by a GP to evaluate other potential causes of his symptoms. That hadn't happened here and now, as a GP myself, I felt obligated to do the full exam.

"All right," I said. "Since you haven't seen your GP for . . ." I pointedly cleared my throat, "some time, I'll start with a complete medical including a neuro exam, and then do a vascular workup. Any problems with that?"

Parsons grimaced. "Would you change your mind if I did?"

"Nope."

"Didn't think so. Then no problems here," he said.

I handed him a paper gown and nodded toward the exam couch. "Everything off but your pants."

* * *

><p>Medical Glossary<p>

Aphasia – impairment of language ability; trouble speaking normally

Etiology – cause of disease or illness

Hemiparesis – paralysis on one side of the body

Paresthesia - sensation of tingling, pricking, or numbness of a person's skin. Often referred to colloquially as "pins and needles" or of a limb "falling asleep."


	4. Chapter 4

It was odd – me, fully dressed in suit and tie and Parsons, colleague and head of my PCT, sitting in front of me almost naked. The thought of examining him didn't trouble me. It was the thought of what I might find that gave me pause.

Difficult as it was, I was prepared to treat him as any other patient. It was one of the big changes I'd had to make from my surgical practice in London. There, I knew almost none my patients. Here, I knew almost all of them so, in that respect, treating Parsons was not all that unusual.

What was rare was for me to be examining a colleague. In London, most of my patients were elderly and it was unusual for my fellow physicians to consult me on a surgical matter involving their own health. In Portwenn, it was virtually unheard of. Occasionally, Samuels, the Wadebridge GP, would seek me out. And there was the unfortunate recent episode with Dr. Dibbs. But other than that, I hadn't examined a fellow doctor in years.

It didn't matter. Parsons was just another patient – except that he wasn't. He was, I had to admit, a friend.

I deferred taking vital signs until the vascular workup and started with a basic neuro exam, as a neurological issue remained the most likely explanation for the symptoms Parsons had experienced. Given his expressed issues with blurred vision and aphasia, I first checked the cranial nerves, focusing on CNs II, III, and XII.

"Look at my nose and don't move your eyes."

He nonetheless rolled his eyes at me. "Mart, I know how it's done."

"Uh-huh." I had Parsons follow my finger through various movements and then carefully examined both the optic discs and the vessels of his eyes. I asked him to show his teeth, shrug, cough, and wrinkle his forehead, all to test neurological responses.

"I feel like an idiot," he said as, at my command, he stuck out his tongue and moved it from side to side.

I didn't even smile. "Neuro exams can have that effect."

My exam wasn't as rigorous as a neurologist would have performed, but his responses were all within normal limits and I was reasonably certain that his ischemic episodes didn't have a neurological origin. And nothing in his history suggested a recent viral problem. Which made it more likely that Parsons' problem was vascular. Time to move on.

His ears, nose and throat were all normal as was my palpation of his neck. I returned the ophthalmoscope to my desk and placed the tips of my stethoscope in my ears.

"Are you always this quiet?" Parsons asked.

"I'm conducting a medical examination not auditioning for a reality show."

"Some casual conversation might help put your patients at ease."

"I don't engage in casual conversation."

He sighed and gave me a limp smile. "No, I suppose you don't."

I had him breathe in and out while I listened to his lungs, which were clear, and his heart, which was without murmur or other abnormality.

"Mart, I must say that, bedside manner aside, you make a damn good GP."

I shrugged. "I'm only doing a basic exam. It's not difficult."

"What _do_ you find difficult?" he asked.

"Having casual conversations with patients. Lie back."

He paused halfway there. "Everything check out so far?"

This time I rolled my eyes. "Yes."

"You'll tell me if you find something that troubles you?"

"Your symptoms trouble me," I replied. When he furrowed his brow at my response, I relented. "Yes, I'll tell you. Now lie back."

As I probed his abdomen, the tension beneath my hands told me that, despite Parsons' light banter, he was quite nervous. Unfortunately, it was making my examination more difficult.

"Relax," I said, switching my gaze to his face.

He grimaced. "Sorry. I'm trying."

I bit back a "try harder," and instead said, "Take some deep breaths."

He did as instructed, and I continued my exam, finding his abdomen soft and non-tender, with no palpable masses. I stepped over to my rolling cart and grabbed a pair of gloves. "Slip off your pants and stand next to the table."

Parsons propped himself on his elbows and frowned. "Come on, Mart. That's not necessary."

I didn't even pause in pulling on the gloves. "I'm your doctor. I'll decide what's necessary."

"Is this how you talk to all your patients?" he grumbled.

"Yes." I seated myself on the rolling stool. "You know these exams are important. You should be visiting your doctor on a regular basis."

"Mart, you sound like a GP."

I looked up briefly. "I am a GP."

"Not for much longer."

True. It was something I should be thinking about constantly – my return to surgery. What I'd desired for so many years, what I'd worked so hard to achieve, was about to become a reality. In but a few weeks, I'd be back in London, at Imperial Hospital, in the operating theatre. And yet, since my aborted departure from Portwenn and the birth of my son, I rarely found myself thinking about my future.

During the day, I plodded through the routine of being the Portwenn GP, diagnosing and treating the mundane ailments of the village idiots. And at night . . . at night, I was with Louisa and the baby and my only thoughts were of the small number of nights the three of us had left together as a family in Portwenn. Even though we weren't a family—

"Mart?"

Blast it! I blinked with the realization that Parsons had been standing there while I reflected on . . . "Sorry," I said with a sigh, mentally shaking off my thoughts and refocusing my attention on my patient.

The urological and prostate exams were unremarkable. I binned my gloves and had Parsons put his pants back on while I washed my hands.

"Everything's normal thus far," I reported. "I'll do the vascular workup now."

It was Parsons' turn to sigh. "Right."

Although it had been several years since I'd last performed a detailed vascular exam, the instant I started it was as if I'd never been away. Given Parsons' symptoms and the lack of findings on physical exam thus far, my major concern was the carotid, but I didn't want to make a premature diagnosis without a complete examination.

"Give me your hands." I carefully examined his arms and legs and checked his reflexes. There was no swelling or other sign of peripheral artery disease. "Now your right arm."

I continued with bilateral BPs, finding them equivalent although slightly above normal. "Your BP's 160 over 86," I told him with a frown.

Parsons shrugged. "White coat syndrome."

"I don't wear a white coat," I pointed out but, ironically, he was probably correct. As I'd already seen this morning, even a doctor had some fear of what an examination might reveal – and especially a doctor with symptoms he knew could be serious. I'd take his BP again at the end of the consultation – if it remained high, I'd consider adjusting his medications.

"Lie back again." A check of peripheral pulses in the carotids, wrists, femoral arteries, and ankles was unremarkable. Yeah, it was almost certainly the carotid.

"Martin, when is this going to end?"

"When I'm finished."

I pressed my stethoscope to his neck, listening carefully to the blood flow through first the right carotid artery and then the left. As I did so, Parsons lay quietly, worried eyes fixated on mine.

"Do you hear a bruit?" he asked anxiously.

I raised my free hand. "Shush."

He scowled but remained silent.

I was surprised Parsons had used the technical term for the sound made by blood rushing past an arterial obstruction. Either he had a good memory from medical school or he'd done some brushing up. When I'd finished my examination, I pulled the stethoscope from my ears and stepped away from the table.

"Get dressed. I'll take some blood and I'll need a urine sample. And I want to take your blood pressure again before you leave."

"So?" he asked, pulling on his trousers.

I sat down at my desk and faced him squarely. "In answer to your question, there is a bruit on the left side. However, that's not always indicative of vascular disease."

"Oh, come on Mart. The TIAs, the bruit . . ."

What I'd said was true. Most people who came to diagnostic conclusions from watching medical shows on TV or from reading articles on the Internet would conclude that a bruit – the "rush" – in one of the carotid arteries – was the primary mechanism for diagnosing carotid artery stenosis. Although certainly one indication, it was insufficient to make the diagnosis and could be present even in the absence of vascular disease. As a physician, Parsons should know that. But, as I'd come to realize, he was thinking like a patient instead of a doctor.

"The repeated ischemic attacks are more worrisome than my findings on exam," I said, adding to his patient notes. "I'll organize an immediate carotid duplex and MRA, which should be determinative."

"Yeah," Parsons said in resignation, buttoning his shirt.

"You know they're not painful."

"It's not the scans I'm worried about. It's the results. Tell me the truth, Mart, what do you think?"

I shook my head. "Chris, the H and P only give me so much information. I can't make a definitive diagnosis without further investigation."

"But," he said meaningfully as he finished tying his shoes and then seated himself across the desk from me, leaning forward in the chair. "Come on, Mart. I came to you because you're the vascular expert. What does all that experience tell you?"

Given Parsons' symptoms, his history of hypertension and elevated cholesterol, and the results of my neuro and vascular exams, I was reasonably certain of the diagnosis even without the confirmatory scans.

I sighed. "That you have carotid stenosis."

Parsons blew out a long breath. "Damn."

I tapped my pen against my open palm. "If my diagnosis is confirmed, it's easily repaired surgically with endarterectomy. A routine procedure."

"You know what they say about routine surgery?"

I stared at him. "No I don't."

"It's surgery performed on someone else."

I rolled my eyes. Carotid stenosis was a serious condition but also a treatable one and certainly preferable to some of the diagnoses in my original differential.

"You should have your scans done in London," I told him, leaning back in my chair.

He blinked in surprise. "In London? Whatever for?"

"The ultrasound requires an experienced technician who performs the test frequently – someone whom I can assure you doesn't exist in Truro. More importantly, if you do need surgery, Leahy and Meadows are in London and they're not going to rely on testing done here. I wouldn't have. So, if you have the tests done in Truro, you'll need to have them redone in London."

"Martin, I'm head of the local PCT. How would it look if I went to London for tests that everyone else has to have done in Truro?"

"It would look like you had common sense."

He gave me an annoyed look. "I'll be fine having the tests here. Besides, I've no doubt you'll be looking over their shoulders every step of the way."

Of that he could be sure. If Parsons was going to let the local idiots run these critical scans, I would at least ensure they were performed properly.

"And if you do need surgery?" I challenged. The best surgeon in Truro was arguably Adrian Pitts and there was no way I was letting him operate on Chris Parsons. If Parsons needed surgery, I'd insist he go to London.

Parsons waived aside my objection. "Let's cross that bridge when – _if_ – we come to it." He stood up.

"I'll book you in for the scans tomorrow."

"I can't tomorrow. I have—"

"Tomorrow," I said with finality.

"Martin . . ." he started ominously.

I raised myself to my full height and stared down at him. "Chris, you wanted my advice. With two TIAs in a fortnight, you're at increased risk for a massive CVA. I think we'd both prefer that didn't happen."

He raised his hands in mock surrender. "All right, all right. Tomorrow."

"Good."

After finishing the blood tests and rechecking his BP, which was now at least close to the normal range, I escorted him into the waiting room. Emily jumped to her feet the moment she saw us.

"Everything all right?" she asked hesitantly.

"Martin wants me to have some scans."

She frowned. "Scans? What's wrong?"

Parsons put his arm around her shoulder. "We'll talk about it on the drive home."

This only seemed to make Emily more nervous and her deep brown eyes flicked to mine, searching for answers. Unfortunately, it wasn't my place to discuss what I'd found. There was patient confidentiality but also, I thought to myself, some things that husbands – not doctors – needed to tell their wives.

"I'll see you tomorrow in Truro," I reminded him at the front door.

It was still raining outside, a situation that was unlikely to change all day. I checked my watch as I returned to the consulting room. I still needed to organize the scans. As I picked up the phone, I reminded myself that I was merely ensuring proper follow up for a patient. Just another patient.

* * *

><p>Medical Glossary<p>

Bruit – Unusual sound blood makes when rushing by an obstruction, such as one caused by plaque clogging an artery

Carotid artery stenosis/carotid stenosis – narrowing of the carotid artery due to atherosclerosis (plaque build up)

Carotid duplex – also called carotid doppler. A noninvasive, painless ultrasound screening used to view the carotid arteries looking for plaques and blood clots and to determine whether the arteries are narrowed or blocked.

CNs – cranial nerves. They are referred to by Roman numerals. CNs II and III relate to the optic nerves and control sight. CN XII is involved in speech articulation.

Endarterectomy - a surgical procedure to remove plaque or a blockage from an artery by separating the plaque from the arterial wall.

H&P – history and physical (medical history and physical exam)

Ischemic – refers to restriction in blood supply

Peripheral artery disease - obstruction of large arteries not within the heart, aorta or brain. Often refers to blockages found in the legs.

Peripheral pulse – pulse that can be felt in the extremities (arms, legs, etc.)

TIA – transient ischemic attack – often called a "mini-stroke." A passing episode of neurologic dysfunction caused by ischemia (loss of blood flow to the brain) without tissue death. A TIA may cause sudden loss of vision, aphasia, slurred speech, weakness, numbness and/or mental confusion as well paralysis on the opposite side of the body of the affected brain hemisphere. Unlike a stroke, the symptoms of a TIA can resolve within a minutes or hours.


	5. Chapter 5

Parsons blew out a long breath. "So, what's the verdict?"

He was seated across from me in a visiting physician's office in Truro Hospital, a functional if unattractive, decades-old metal desk between us. It helped reinforce my role as Parsons' GP and not merely colleague and friend.

Parsons, in a dress shirt, trousers and jacket, but absent a tie, seemed outwardly relaxed and still showed no lingering effects of his attack several days ago. Nonetheless, I'd detected apprehension in the way he'd carried himself when he'd entered the room and, now again, as he picked at the upholstery on the chair awaiting my diagnosis.

He'd had the scans I'd ordered earlier in the day. I knew he was anxious to learn the results, and that he needed to hear them directly from me. Since we were both present in hospital, there was no need to subject both of us to the long drive back to my surgery to discuss the issue. Thus, we were meeting in this barely functional room where, quite frankly, neither of us was particularly comfortable.

"The scans confirm you have carotid stenosis," I said formally, clasping my hands together atop the desk. It was one of the few times I took little satisfaction in being correct with my diagnosis, one I'd given probably a thousand times in my career as a vascular surgeon, much less frequently in my days as a GP. Carotid stenosis was a serious condition, but also a curable one. I watched to see how Parsons would take the news.

His eyes held mine and reflected resignation more than fear. "Well, it's what you suspected all along." His fingers drummed along his leg. "I assume you're recommending surgery."

"Yes. The scans showed a significant narrowing of the left carotid – more than 80 percent. Surgery is your best option."

"You don't mince words, do you?"

I never did. "The diagnosis is straightforward, as is the recommended treatment." I forced myself to remain professional and not allow myself to think of Parsons as anything more than another patient.

He sighed again and leaned back in the chair. "Damn."

"It _is_ routine surgery," I reminded him. "You're young for this type of surgery and in overall good health. The risks are minimal."

"Easy for you to say."

"Yes, it is. And it also happens to be true."

"So, assuming I decide to have the surgery, what comes next?"

"I call Leahy or Meadows and get you on the list as soon as possible."

"You really think it needs to be done right away?"

"I do. Every day you wait increases the odds of having a CVA," I added, somewhat unnecessarily. He knew the risks.

Parsons sat there for a moment, twisting his hands. Finally, he looked up and I suspected that I wasn't going to like the next words that came out of his mouth.

"I know I shouldn't ask this Mart, but any chance you could do the surgery?"

"Me?" I couldn't control the expression of surprise that must have crossed my face. I certainly hadn't expected _that_ question.

"If I'm to have this bloody operation, there's no one I trust more than you to do it."

Bloody operation, indeed. "I'm, um, flattered, but—"

"And, all things being equal," Parsons prattled on, "I'd rather be operated on by you here in Truro than by some so-called expert in London."

"Chris, I'm . . . I haven't exactly started up again as a surgeon, you know."

He waved off my comeback. "Come on, Martin, you did this surgery for years. You could probably do it in your sleep – though I hope you'll be awake for my procedure," he added with a wink. "Besides, if fate hadn't intervened, you'd be in London right now. What better way to restart your surgical career than a routine procedure on someone you know? And, someone whom you yourself said is at least a decent surgical candidate."

Factually, he was correct. Parsons' case was relatively simple from a surgical perspective. The procedure could be done right here in Truro. And I was unquestionably the best vascular surgeon between here and London. This was the perfect situation for me – a way to get my hands back in surgery, so to speak, while I was waiting to take up my position at Imperial.

So why was I hesitating? "I don't even have surgical privileges here," I protested.

"That's easily arranged. You have privileges at Imperial. A few calls and faxing of documents is all it takes."

He had a fair point and we both knew it.

"And besides," he continued, apparently taking my silence for acquiescence, "I know it will make Emily much more comfortable about the whole thing. She's scared half to death, and you're the one person she'd actually trust to cut me open."

Parsons, damn him, had the whole thing sorted. Everything he said made perfect sense. A quick, uncomplicated vascular procedure away from the limelight of London on an otherwise healthy patient who wasn't likely to complain about my bedside manner, surgical skill, or anything else.

I grabbed a ballpoint from the desk, suddenly longing for the fountain pen I loved to fiddle with when I was contemplating. I pulled the cap off and pushed it back on, off and on, off and on.

"Mart?"

I looked up, suddenly realizing I'd been playing with that blasted pen for God knew how long.

"Something wrong?" Parsons asked solicitously, brows furrowing.

"No," I replied quickly, too quickly. Thankfully, Parsons didn't seem to notice.

"Then you'll do it? My surgery?"

Of course I could do it, I assured myself. This is what I'd spent the last six months preparing for. If I couldn't handle a simple carotid endarterectomy on an otherwise healthy patient, how would I ever deal with the complex vascular cases for which I'd been renown and which I would again be expected to perform on a daily basis?

"Yes." The word came out almost before I realized I'd said it. A clench in my gut told me that, for better or worse, I was in.

I looked down at the desk calendar and spoke quickly, lest I give myself a chance to change my mind. "Let's see. Today is Monday. I'd like to schedule surgery for a week from today. That will give me time to get my privileges organized and for you to have the necessary pre-op work."

It all sounded so routine. It _was_ routine, I reminded myself. Perfectly routine. Just as I'd imagined it would be. Exactly what I needed.

We both looked up at the sound of a soft knock on the door. When Parsons opened it, Emily was standing outside.

"Oh, sorry," she said. "Chris, your office said I'd find you here. I can come back . . ."

"No, it's alright," Parsons said. "Mart has convinced me to have the surgery we talked about, and I've convinced him to do it."

Emily clutched her husband's sleeve and swallowed deeply several times. I could see that she was struck by the news but also trying to regain her composure before speaking.

"The scans showed . . ." she started, turning her gaze to me.

"Carotid stenosis," I finished. "A narrowing of the carotid artery. It supplies blood to the brain."

"Right." Emily took a deep breath. "So you think surgery is the best option, Martin?" she asked.

I nodded. "I do."

"Well, thank goodness you're doing it. I know Chris will feel much better knowing he's in your hands and I can't begin to tell you how much better it makes me feel as well." Her hand snaked down and grasped her husband's firmly.

I wasn't sure who was giving and who was receiving support, only that the two of them seemed to cling to each other. It reminded me of . . . no, I wouldn't let my mind drift back to that day. I shifted from one foot to the other, unsure what to say or do. They were both counting on me, counting on the surgeon I'd once been and one that I hoped I could be – no, _needed_ to be – again.


	6. Chapter 6

I sat stiffly in the uncomfortable seat that currently served as my consulting room chair. I was still using Dr. Dibbs' furniture. Given that I'd only be in Portwenn for another few weeks, it hadn't made sense to bring back my own things, which remained in a storage warehouse on the outskirts of London awaiting my arrival.

Next week's endarterctomy on Chris Parsons would be the first step in reestablishing my surgical career. The world of vascular surgery was extremely small; news of my return to surgery would spread like wildfire. For that reason alone, ensuring the surgery was not only successful but executed flawlessly was an absolute imperative. And, of course, nothing was more important than making sure I provided Parsons the absolute best care possible.

My laptop was playing the audio CD sent to me by that juvenile psychiatrist Edith had convinced me to see. He'd been an imp but, I had to admit, the CD had been more useful than expected in helping overcome my hemophobia. Things had gone well of late. I'd not reacted to the bleeding scalp injury from the workman who'd fallen off the ladder or Morwenna's bleeding foot or even the patient with the bloody nose. Although I'd blanched at the sight of Aunt Ruth's bloody hand, I'd managed to cover that one small slip.

Still, I knew that those incidents were nothing compared to the omnipresent blood I'd experience in my first full surgical procedure in several years, an operation I'd be performing in a few days on my closest colleague. I couldn't fail.

On the desk in front of me was a pig liver I'd purchased from the butcher. I would listen to the CD, mentally walk myself through the procedure and, at the appropriate moments, visualize the liver as the neck of Chris Parsons. Parsons probably would have laughed had he seen me. Or, maybe not.

I closed my eyes. The monotonous but eager young voice of Dr. Marcel Milligan droned on, reassuring me that I was in control of all around me.

"_Imagine you are standing in the operating theatre, controlling the area where you are standing . . . Your domain . . . Standing in your scrubs. Your patient is prepped, and the field sterile . . ._"

I imagined myself in surgical garb striding purposefully toward the table. The patient was laid out under sterile blue sheets, only the head and neck exposed. In theatre were the scrub nurse, the circulating nurse, the anesthetist, and the junior surgeon who would assist me. Given that I'd never operated in the Truro hospital before, they were unknown to me – merely sets of eyes above their surgical masks. Gleaming stainless steel instruments were laid out in meticulous rows, awaiting my use. The room was cool. The monitors beeped and hissed at appropriate intervals. It was all as it should be.

I took a calm, cleansing breath.

I'd done this procedure more than a thousand times. As Parsons had said, I could almost do it in my sleep. Start with a vertical incision along the anterior margin of the sternocleidomastoid . . . dissect through the carotid sheath . . . clamp the artery to reveal the obstruction . . .

"You are in charge, in control." The voice of Dr. Milligan urged me on.

Yes, I was.

The circulating nurse approached with a gown and gloves. She wrapped the gown around me and tied it in back. I slipped each hand into waiting gloves, size XL as always, and wiggled my fingers to ensure the gloves fit tightly and were comfortable. I was in control, in command. The others in the room were simply awaiting my next move.

"_You are ready. You walk over to the table and make eye contact with the anesthetist_," the tape continued and I wondered just how many times Dr. Milligan had actually been in an operating theatre.

"He's ready for you, Mister Ellingham," the anesthetist said from behind his surgical mask.

"_It is simply a patient. A person you will cure through your surgical skill. A body."_ Dr. Milligan's comments mimicked my approach to all my surgeries. . . until that one fateful day.

A patient. A body. A disease for me to cure. Nothing more than that.

"_You walk towards the patient and pick up a scalpel. You prepare to begin the operation . ._ ."

I looked down at the surgical field. Because I would be working on the neck, there was no way to avoid seeing the patient's face.

It was Chris Parsons, eyes closed in anesthesia-induced sleep. He looked so peaceful, content in the belief that my surgical skill would save him.

Focus, Martin, I told myself. I nodded to my team. "Let's begin," I said with more confidence than I felt.

"_Your skill is all that you need. You are in control. Focus on what you need to do. Pick up the scalpel."_

"Scalpel." I held out my hand.

And watched as Parsons' face morphed into that of the elderly woman, my patient of five years ago.

"No!" I gripped the scalpel as tightly as I could. It was today and Parsons was my patient. I could do this.

"_Visualize every sense. You are in control."_

It's only a patient, I told myself. Make the incision. I closed my eyes. I saw Emily clinging to Chris, the elderly woman's son and husband clinging to her. They were counting on me. They trusted me.

"Mister Ellingham?"

I breathed. There was a sound coming from the computer. I was . . . in . . . control.

I made the incision into the neck – into the pig liver in the steel basin resting on my desk. Blood poured out.

Blood. The pig's blood. Chris Parsons' blood.

Oh God. Bile rose from my stomach to my throat. I blinked rapidly, trying to focus on whatever Dr. what's-his-name was saying. Blood. Bloody surgery, Parsons had called it. It was simple, so simple. I could do this.

"Mister Ellingham? Are you all right?"

I couldn't quit now. Chris . . . and Emily were counting on me. I looked back down at the incision I'd made. My assistant had brought out the cautery. The smell . . . the blood, the cauterized flesh . . .

"_Focus only on the your surgical technique . . ."_

I swept the laptop off the desk along with a collection of tongue depressors, pens, and paper. It all landed on the floor with a dull thud, and it seemed that maybe the annoying Dr. Milligan was finally silenced. I jumped up from the desk and dashed to the sink, heaving my lunch and bile until there was nothing left to come up.

Spent, I rinsed and wiped my mouth and stood over the sink, sucking in deep breaths and wincing at the smell of my own vomit.

"Martin?"

I snapped around to see Louisa standing at the door to the consulting room. Why was she here? How much had she seen?

"Martin? I stopped by to . . . I heard a crash." Her eyes flicked to the mess on the floor. "What happened?" she asked, giving me a worried look.

"Get out!"

"Martin?"

"I said to get out." I took a few steps forward and slammed the door in her face. Behind me, Dr. Milligan was still talking.

"_You are in control . . ._


	7. Chapter 7

"You have a urinary tract infection, Mrs. Trammel," I said wearily a few hours later. The condition was one of the more common reasons patients – especially female patients – came to see me. Annoying for the patient, but easily treated.

"It's _Miss_ Trammel," the prim woman corrected me.

I favored her with a hard stare and scribbled out a prescription. "Antibiotics." I ripped the sheet off the pad with a flourish. "Be sure to take the full course. If you're not feeling better in a week, come back and see me."

"See _you_? Really?" she said in surprise. "I thought you were going back to London and we were getting a locum."

"My departure has been . . . delayed . . . a bit."

"Of course. Joan." The woman clucked her tongue in sympathy. "It was such a shock, her passing so suddenly like that." Her expression morphed into a smile. "And of course, there's your baby."

There was no benefit in discussing my personal life with my patients. "Next patient!" I called out, and headed toward the doorway, using the opportunity to usher my patient toward the waiting room, which at this late hour, I found to be empty.

"All done for the day, Doc," Morwenna informed me.

A glance at my watch showed that it was already past her normal working hours. "You can go," I said, turning around and heading back into the consulting room, remembering to dip my head so as not to bang it into the doorframe – something I often did when my mind was elsewhere. I still had patient notes to finish up and, in the meantime, I could figure out what I was going to say to Louisa. That was, of course, assuming she'd see me given my behavior of a few hours ago.

I also needed to decide what to do about Chris Parsons and his surgery, which I was scheduled to perform in only a few days. The flashback earlier today had frightened me – and had seriously dented my newly found confidence. I dare not have that happen with Parsons on the table. At best, I'd look like an incompetent fool. At worst, my jitters might occur in the middle of surgery when a mistake could actually kill the man.

I carefully wrote out my notes for the last patient, wondering not for the first time whether I should consider moving to a computer-based system. The act of writing by hand was strangely cathartic and seeing the progression of penmanship from one year to another, one doctor to another . . . I didn't know why I was having this mental debate. In less than a month, I'd be in London where all surgical notes were dictated and left for a medical transcriptionist.

I glanced up at the sound of a soft knock at the door.

"Surgery's closed, unless it's an _actual_ _emergency_," I barked out, emphasizing the last two words in the hope that whoever had come to bother me would leave. And also hoping that I wasn't inadvertently shouting again at Louisa, although odds were that, after my earlier tirade, she was wasn't likely to return to my consulting room.

"It's only me, Martin," Aunt Ruth said, pushing open the door.

I frowned at her unexpected presence. "Are you ill?" She looked fine, if a bit drawn, dressed as always in a proper navy suit with a crisp white blouse.

She favored me with a half-smile. "I'm not here as a patient."

Well then, this wasn't hard to figure out. Argue with Louisa at lunch, receive visit from Aunt Ruth at the end of the day.

"Louisa called you." It was more an accusation than a question.

"I called her," she corrected me. "Needed to find somewhere to get my hair done. When I asked after you, she mentioned you'd been a bit out of sorts." Her voice remained quiet and her eyes searched mine.

"I can handle my own problems, thank you," I said, standing up and, for the second time in a few minutes, tried to usher a woman out of my surgery.

To her credit, my aunt stood her ground. "Martin, may I ask you something?"

"Do I have a choice?" I asked in a tone meant to discourage further questioning.

"Are you looking forward to returning to London?"

"Of course," I replied automatically.

"And Louisa?"

"She's coming with me."

"I know that. But is she happy about it?"

I shrugged. "I suppose so." I hadn't given it much thought.

"Haven't you asked her?"

"No need."

Her eyebrows arched and she gave me a feigned expression of surprise. "Really? You're asking Louisa to quit her job and move away from the town where she's spent her entire life because you decided you want to work in London. Don't her views count?"

"I considered her views," I replied defensively.

"And dismissed them, I'm sure." She swallowed hard and cleared her throat. "In London, you'll be working incredibly long hours. Have you thought about what life will be like for Louisa alone all day with a baby in a small flat?"

"It was _her_ decision. I'm sure she'll manage."

"I'm sure you're sure."

What she'd said was true. My decision to return to surgery and London had been made while Louisa was away so there'd been no need to consult her. By the time she'd returned to Portwenn, everything seemed so . . . settled. And, when she'd told me that she didn't want me involved in the baby's life – James Henry's life, I reminded myself – there seemed no reason to change my plans or even to involve her in them.

Once James was born, it had suddenly and unexpectedly become important to have him and Louisa in my life. And that's how I'd thought about it . . . how they would fit into _my_ life, not how I could fit into theirs. Louisa could quit her job – or find herself a new job in London. Louisa could move to the flat I'd rented. Louisa could take care of the baby while I worked. My future involved a lot of concessions by Louisa and, I had to admit, not too many by me. Perhaps it was because, until now, I'd never had to consider the effects of my decisions on anyone but myself.

"So then, what happened at lunch?" she asked, taking a seat in front of my desk. My aunt was looking at me curiously, and it didn't escape my notice that she'd suddenly switched subjects on me.

I tried to deflect the question. "Nothing important."

"I don't believe that for a moment."

"Aunt Ruth, I don't need yet another psychiatrist trying to psychoanalzye me."

Her eyebrows again flicked upward. "Another?

Damn. "It's none of your business."

"Oh for God's sake, Martin. I don't need to be a psychiatrist to know that you're upset about something. You've been tense since I arrived in Portwenn and, in the last couple of days, you've been almost impossible to be around." She coughed and cleared her throat. "Louisa's convinced it's her fault – that she's done something wrong."

"It has nothing to do with her."

"Then what is it?"

My eyes narrowed as she coughed again, harder this time, and pulled out a tissue from her bag.

"Are you having more problems with the Sjogren's," I asked. "Are you drinking plenty of water?"

"It's fine."

"No, it's not fine." I grabbed a tongue depressor and stepped around the desk, clicking on my pocket light. "Let me see your throat."

"Oh, for goodness sake," she complained, but nonetheless opened her mouth. To my surprise, it was less dry than the last time I'd examined her, although somewhat inflamed. I let my hands slide down the sides of her neck and found her lymph glands slightly swollen.

"Hmm." I nodded toward the examination table. "Have a seat on the couch and loosen your blouse."

"Whatever for?"

"You're coughing and short of breath; I want to examine you." The coughing was probably nothing more than a virus, but pneumonia was always a possibility and, if left unchecked, could be quite serious in someone Ruth's age.

She gave me an exasperated look. "Oh, Martin."

"Just do it."

I grabbed my stethoscope from the desk and, when she was ready, listened carefully to her lungs. It took only a few breaths to hear the telltale crackles. "It's acute bronchitis," I said, pulling the stethoscope from my ears. "Most likely viral. You should be fine with over-the-counter NSAIDs and cough suppressants from the chemist."

She started tucking in her blouse. "I could have told you that."

"Right." I again sat down behind my desk.

"Martin, why are you so anxious to go back to surgery?"

That was easy. "I spent half my life training to be a surgeon. And I happen to be very good at it."

"You're also an excellent GP – at least from what I've heard and seen since I've been here." Aunt Ruth slid off the couch and leaned against it, folding her arms across her chest. "You have a home here, and a successful practice. Louisa and your son are here. Why are you leaving everything you've built over these past years to go back to London?" She coughed into her hand, and grabbed another tissue from her handbag.

I took a deep breath. "Oh, I don't know. Could it be that the town is an abysmal backwater, the medicine isn't the least bit intellectually stimulating, and my patients are, for the most part, ungrateful and non-compliant fools?"

"And that's why you're leaving?"

I raised my eyebrows. "I think that's more than enough, don't you?"

"Perhaps. And yet it seems you're doing almost everything you can to stay here."

"No I'm not," I replied indignantly. "I'm only _staying_ because Aunt Joan died and then my replacement at Imperial refused to come for—"

She waved off my excuses. "You're not going to tell me, are you?"

"Tell you what?"

"What's really bothering you. A few weeks ago you accused me of hiding something. Well, at the moment, Martin Ellingham, you're the one doing the hiding."

Damn her. For a moment, I wished for Auntie Joan, who'd give me a good talking to but, in the end, would leave me to stew in my morass. Aunt Ruth wouldn't quit. Hard to say whether it was her personality or her profession – probably both.

"It might help to talk about it," she added.

"No it won't," I snapped. "Besides, there's nothing you can do to help."

She coughed again, then took a seat even as her eyes appraised me. Finally, she said, "I can listen."

* * *

><p>Medical Glossary<p>

NSAIDs – non-steroidal anti-inflammatory drugs, such as ibuprofen and aspirin.


	8. Chapter 8

I wasn't sure I wanted to talk about my situation with anyone. It was my problem and I could deal with it on my own. However, I had to admit that my plan wasn't exactly working. It was now only a few days from Parsons' endarterectomy, and I was less certain than ever that I should, or even could, do it.

I went into the kitchen, grabbed a glass of water for Ruth and an espresso for myself. It gave me a few brief moments to collect my thoughts and decide what, if anything, I'd tell her. I could remain quiet or I could share my concerns with someone who might be able to provide some advice on how to proceed. Because, God knew, at the moment I was fresh out of ideas.

Once back in my consulting room, I handed Aunt Ruth the water and then reseated myself in my desk chair. My eyes found a spot on the wall behind her.

"All right. If you must know, I'm afraid to operate on Chris Parsons." I let the sentence sit between us, wondering what her reaction would be. It took less than a second to find out.

She paused in mid-sip, eyes widening. "What?"

"Carotid endarterectomy, Monday morning. I'm supposed to operate and I'm afraid to do it."

Her eyes narrowed. "Slow down, Martin. Who is Chris Parsons and why are you afraid of his surgery?"

I briefly explained my relationship with Parsons and my agreement to operate on him the following week. "You know about my little blood thing," I added, as I was sure she did indeed.

"Joan mentioned it. Said you were cured."

"I am cured." I exhaled loudly.

"Right." She nodded. "So why are you worried about operating on Parsons?"

I slammed my hand onto the desk. "I don't know!"

Ruth held up her hands. "All right. Why don't we start at the beginning?"

I gave her an annoyed look. "I'm not your patient."

"No." She shook her head and gave me an appraising look. "But it might help to talk to someone about this."

So, for no reason at all I went through the entire miserable story, starting with that fateful day in London and finishing with the panic attack I'd had only a few hours ago. Aunt Ruth let me talk without interrupting, for which I was unexpectedly grateful.

When I'd finished, I shrugged. "So there you have it."

"Since you've overcome the hemophobia, have there been any times other than today when you've felt ill at the sight or smell of blood?"

I still blushed at the memory. "When James Henry was born. I vomited at the sight of him before they'd cleaned off the blood." Louisa, bless her, had laughed it off. The ambulance attendants hadn't been as considerate.

Her eyebrows lifted at that. "Any other times?"

"One other." I wasn't sure I wanted to admit this one. "I felt a bit nauseous when I was cleaning your wound, the cut on your finger."

"Interesting. And then there was just the _thought_ of operating on Parsons," she said. "What do you think, Martin?"

"I told you. I don't know."

She eye me steadily. "I think you do. You just aren't willing to admit it."

"Stop it! Enough with the psychobabble."

"All right then. I'll spell it out for you. Since you conquered your hemophobia, you've had trouble dealing with blood involving only three people. Your son. Your aunt. And now, your best friend."

"All people I . . . care about," I admitted, with a deep sigh.

"Yes," she replied with a brief smile. "My guess is that you care about all your patients. Behind that cold exterior is a doctor – and a man – with a great deal of sentience. However, in order to do your job, you have to sublimate those feelings; all doctors do or we'd never be able to function. Most of us find outlets, appropriate and otherwise, to deal with the suffering. Some take up hobbies; some turn to alcohol or drugs. For you, it apparently manifests as a fear of blood. With various techniques, you've learned to control it – apparently unless the person involved is someone you truly care about."

That made a certain sense. "So how do I fix it?"

It was her turn to sigh. "I'm not sure you can."

I sat there, stunned. What did she mean I couldn't fix it? I _had_ to fix it if I was going to continue to work as a surgeon. "I don't believe that."

"You can't fundamentally change who you are."

"But I was a surgeon for years. I operated almost every day and never had a problem. Why – why can't I do it again?"

"Martin, without a full psychological examination there's no way I can even begin to figure out what triggered that first event. Even if it were ethical for you to be my patient, which it isn't, I don't think that's what either of us wants or that such an analysis would actually help."

I narrowed my eyes at that.

She took another drink of water. "It's not unlike a soldier exposed to the horrors of combat on a daily basis without being affected. Then, one day, some random and maybe even minor event triggers a breakdown and he's no longer able to function. Something along those lines may have happened to you. And like the soldier who can't be sent back into battle, I'm not sure you'll ever be able to perform surgery, at least on a full-time basis."

Was she suggesting I was suffering from surgical combat fatigue? "Meaning?" I asked as I tried to get my mind around that.

"I think you could probably do minor procedures, probably even handle the occasional surgical emergency. In fact, I'd guess that you'd have the easiest time in an urgent situation - when you're the only one who can help. Most of the time you'll be fine. But I fear it _will_ be a struggle, each and every time you step into theatre. And, on occasion, maybe without warning, it won't be fine. You'll react just as you did to your son, and to me, and to Chris Parsons." She blew out a long breath. "I'm not saying you can never operate again – just that I'm not sure you can have a surgical career."

I didn't know whether to believe her, and certainly didn't want to. Yet, if what she was saying was true, it meant my future, all of my carefully laid plans, were doomed. I couldn't be a surgeon again. I couldn't go to London. And I certainly couldn't operate on Chris Parsons.

"I'm sorry, Martin." She shrugged. "And I may be completely wrong."

But she wasn't. In my heart, I knew she was correct. My ability to handle blood was directly related to who was bleeding. And, for a surgeon, that was a recipe for disaster. "If you're right, what am I to do?" I asked.

She took a deep breath and coughed slightly. "Start by talking to Louisa."

"Louisa? What does she have to do with this?"

"If you plan to stay together as a couple, you need to start talking to each other, consulting each other. She can help you get through this. If you let her."

I couldn't imagine sharing my weakness with Louisa. I'd only told her about my blood issue after she'd already heard about it and then only because there was little choice in the back of Peter Cronk's ambulance.

"What do I tell her?" I asked, helplessly.

"The truth," my aunt said simply.

* * *

><p>Author's Note: Thanks to all of you who've commented on my story. I've having issues with the ff. net review reply URL not working (says it's "out of date"), so haven't easily been able to reply personally in many cases. Hopefully, the situation will resolve itself. In the meantime, know that I greatly appreciate each and every comment.<p> 


	9. Chapter 9

I closed the door to the surgery and stepped through the alcove into the kitchen. Out of the corner of my eye, I saw Louisa curled up on the sofa in the sitting room. The baby was nowhere to be seen, which meant that he was upstairs, asleep in his cot.

I steadied myself, determined to do what Aunt Ruth had suggested and explain myself to Louisa. After this afternoon's tirade, I at least owed her that much.

"Louisa," I said softly, not wanting to wake her if she too was taking a nap. She always seemed so tired of late juggling school and the baby. It was as difficult as I'd expected but reminding her of my concerns only put more strain on our already strained relationship.

"Martin." Her eyes opened and she gave me a soft smile. "Everything alright?" If she was angry with me for my actions earlier in the day, she gave no sign of it, for which I was thankful.

"Fine," I lied.

"I saw Aunt Ruth heading down the walk a bit ago," she said. "You should have invited her to stay for supper."

"She, uh, needed to get back to the farm. Before dark, that is."

"Oh."

I sat down next to her on the sofa and she pulled up her feet to give me room.

"Louisa, I was rude this afternoon, when you came to the consulting room. I want you to know. . ." I couldn't quite meet her eyes. "My being upset; it wasn't directed at you." It was my best attempt at an apology.

Her eyes narrowed. "Did something happen with a patient?"

"No."

"With Morwenna then? You didn't let her go her did you?" she asked with some apprehension.

"No. She was fine. Today that is."

She sighed with relief. "Good."

I sat there, stupidly trying to figure out what to say next. It had been relatively easy with Aunt Ruth; why did I always find it so difficult to talk to Louisa? We seemed to talk at angles, with neither of us being able to express our feelings plainly to the other which invariably led to misunderstanding and, frequently, a row.

"Louisa, would it make you unhappy if I – we – didn't go to London?"

She sat up straight and gave me a look of astonishment. "You mean stay here awhile longer?"

I shook my head. "I mean if we didn't go at all." I let the statement rest between us.

"Not go to London?" There was a note of hesitation in her tone. "But it's all settled. I mean that's where your position is, where you're planning to work. Surgery and all that."

Yes, I was well aware of my plans. I tried again. "What if I were . . . not to take the position at Imperial?"

"Not take the position at Imperial? I thought that's what you wanted, what you've been working for all these months."

"It is." I had trouble meeting her eyes. "It was."

"I'm sorry, Martin. I'm don't understand. I thought it was all settled. You're going back to London, to vascular surgery . . ."

"I may not be able to go back to surgery." There, I'd said it. I'd done what Aunt Ruth had suggested and told Louisa the truth. I mentally held my breath to see what she would say or do next.

She was staring at me curiously, eyes wide. "Not go back to surgery? Why not?"

I wet my lips. "Earlier today, before you came to the consulting room, I was mentally reviewing Chris Parsons' surgery, imagining myself performing the operation. Step by step." I left out the part about the pig's liver.

She nodded.

"And . . . I experienced a . . . panic attack. The surgery, the blood, the cautery . . . I couldn't do it."

"That's what had you so upset when I came by, wasn't it?"

I nodded. "Yes."

Louisa's mouth hung open as she seemed to process what I'd just told her. "Oh, Martin."

Please, I silently begged her. Don't pity me. The one thing I could not endure from Louisa of all people was pity.

"And you think it could happen again when you actually operate?" she asked in a quiet voice.

"I'm afraid so, yes."

"On any patient?" Louisa had figured it out quite quickly.

"Well, it's unlikely on just any patient." I cleared my throat. "Aunt Ruth seems to think it's only – mostly – when I operate, or think of operating, on people . . . who are close to me. That I would probably be fine most of the time - with most patients. But, I can't be sure it won't happen againt. I might never be sure."

She took a breath and stared down at her hands, which were clutched together. "Martin, I . . . don't know what to say."

Then don't say anything, I thought. I'd done what Aunt Ruth had suggested in unburdening myself to Louisa. I really didn't want to get into an in-depth discussion of my psychological issues. If Ruth was correct, there was nothing I could do about the situation and definitely nothing Louisa could do about it.

I stood up quickly, hoping to dispel further conversation on the subject. "I'll fix some supper. Maybe we can get in a meal before the baby awakens."

She trailed me into the kitchen. "If you don't take the position at Imperial, what will you do?"

I gave her what I was certain was a dark look. _How the hell do I know? _ _Can't you see that my entire world has just been upset like a bloody applecart? _My position, my career, my future.

Louisa must have sensed my consternation because she took a step back. "You'll sort out something, I'm sure," she offered lamely.

I, in turn, did my best to force back my teeming anger. This wasn't Louisa's fault and lashing out at her would only push us back to the days when we couldn't seem to have a single conversation without arguing.

"What do you suggest I do?" I asked, trying to keep the sarcasm out of my voice. I was sure Louisa, as always, would have a dozen ideas, things to make things better, ideas to make _me_ better. I couldn't wait to hear them, I thought sarcastically.

"You're asking me?"

"Yes," I reassured myself as much as Louisa. "Yes, I am."

It was almost amusing – almost – to see her so flummoxed. And, it was, I realized with a profound sense of guilt, because this was probably the first time I had actually consulted her on any decision affecting me.

"Well, I don't know, Martin. With your skill, I'm sure you could work anywhere you like."

Not as Chief of Vascular Surgery at Imperial, I thought.

"I know you don't want to stay here in Portwenn," Louisa continued.

It was true that I'd made quite clear to anyone who would listen that I was more than anxious to get out of this village. Permanently. I'd burned quite a few bridges in that regard. There were undoubtedly openings for GPs in other parts of the country – maybe even London, I thought with a sense of irony. And, I could work as a locum for a time, until I sorted things out. At the moment, it all seemed too overwhelming.

I opened the refrigerator to see what I might fix for dinner. "There's no need to decide this evening."

She looked somewhat disappointed that I was ending the conversation. "No, I suppose not. So, what happens next?"

"I need to give my notice at Imperial. But first, I need to tell Chris that I can't perform his surgery," I said with a sense of dread.

She slid a bit closer to me. For a moment, I thought she might touch my shoulder or even take my hand. Instead, she simply gazed up at me, her head slightly tilted. "Would you like me to come with you when you talk to him?" she asked softly, and, I couldn't help be touched.

"No," I said quickly. "I, uh . . . this is something I need to do on my own."


	10. Chapter 10

Parsons opened the door to his home, dressed in a loose-fitting jumper and baggy trousers. His expression of surprise at seeing me immediately turned to worry as he considered the reasons that I would be on his doorstep only days before his surgery.

"Mart?" His eyes narrowed. "Is something wrong?"

"Uh, no. Not exactly," I managed to stammer. "May I come through?"

"Yes, of course." He led me into the living room and pointed me to an easy chair. "Should I get Emily?" he asked nervously, sitting down on the sofa across from me.

"No, I shouldn't think so."

"There's something wrong, isn't there? Something with my pre-op workup?"

"No, everything checked out fine." His tests had been completely normal – for someone with carotid stenosis, that is.

Parsons blew out a long breath in obvious relief. "Then what's the problem?" he asked a bit more cheerfully, before his face clouded. "Nothing wrong with Louisa or the baby is there?"

"No, nothing like that. They're both well."

What I didn't tell Parsons was that they were well but that my relationship with Louisa was not. The night before last, Louisa and I had had an unexpected row that ended with her walking out on me. For reasons I couldn't quite fathom, she was angry that I'd set the date for James Henry's christening without consulting her. And, stupid as I was, I'd let her go. I'd stood there watching as she walked out of my home and, for all practical purposes, out of my life. I could have stopped her, could have said the right things that might have convinced her to stay. I could have told her that I loved her and loved James. Instead, I once again stood my stubborn ground and let her walk away, this time with our son in tow.

Parsons didn't need to know all that. It had nothing to do with his surgery and he had more than enough on his mind without having to deal with my problems with Louisa – especially given the news I was about to deliver.

He waited expectantly for me to continue. For my part, I couldn't bring myself to begin. How would I once again tell him about my weakness, my failure, which this time would affect him directly?

"Mart?" he asked hesitantly, once again concerned. "Are _you_ okay?"

"Yes. Well, no." I couldn't meet his eyes. "It's about your surgery. I've, uh, I've arranged for Nigel Leahy to do it."

Parsons simply looked at me for a moment, his eyes narrowing. "May I ask why?" I could see he wasn't entirely pleased at the news, even though Leahy was arguably the best vascular surgeon in the UK.

I couldn't tell him, couldn't bring myself to say the words. And, then, it was as if he sensed the depth of my consternation.

"Is it because you know me?" Parsons asked quietly. "Are you worried you won't be able to be objective?"

Close, I thought to myself. I kept my gaze averted. "I'm afraid I might kill you."

His eyes widened. "What!"

Oh God. First Aunt Ruth, then Louisa, and now Parsons. How many times was I going to have to go through this? I took a deep breath. "The other day, I was imagining myself performing your surgery, mentally reviewing the procedure and I . . . had a flashback."

Parsons gave me a look of confusion.

"To the day in London, my patient, when I first experienced my . . . blood issue."

This time Parsons eyes clouded over and it seemed they almost misted. "Martin, I don't know what—"

I plowed on – best to get it all on the table. "Ruth, my aunt, she's a psychiatrist, believes that the hemophobia isn't fully gone and may never be. And when my patient is a relative, or a friend even, it's more likely to recur. So you see, I can't operate on you. Not tomorrow and probably not ever. In fact, I doubt I can be a surgeon again at all."

He sat there in silence for a long moment. "Are you sure?"

"Chris, I can't go into theatre unless I'm fully confident in my surgical skill. If I were to falter while I was working on a major artery, we both know the consequences. I can't let that happen with any patient and especially not with you."

"Damn, Mart. I'm so sorry, so very sorry. I know how much surgery means to you."

I brushed off the concern. "I've already called Leahy. He's agreed to come to Truro to perform your surgery a week from Thursday. Dinwiddie will assist; he's good."

"Not sticking me with Adrian Pitts, huh?" Parsons asked with a smile.

I hung my head in shame. "I know you were counting on me and Emily trusted me . . . I don't know what to say."

"Mart." Parsons reached out his hand to touch my knee then seemed to think better of it. "It's not your fault. You have an illness every bit as real as mine. I don't blame you in the least and neither will Emily. Besides, how can I complain after you convinced the second-best vascular surgeon in the UK to come all the way to Truro for a poor sod like me?"

I managed a limp smile at that comment. "It was the least I could do." Leahy was a good man – one of the few who hadn't taken some inane pleasure in my bout with hemophobia and who, when I'd called last evening, had been willing to help out even though he had no cause to do so.

"Look." Parsons interrupted my thoughts. "I know this is going to disrupt your plans – Imperial and all that. Think about what you want to do and, after my surgery – if all goes well, we'll talk. I've some ideas that might tempt you."

This time I was the one left momentarily speechless. Parsons was facing major surgery, his surgeon – me – had pulled out on him at almost the last hour, and yet his first thought was of me, of my future. It was much more than I deserved.

"Of course, all will go well," I replied automatically, referring to his comment about the surgery.

"Yeah."

"Chris, I've told you there's no call to be worried."

"Intellectually, I understand. I know this is routine surgery, I know I have a great surgeon even if it's not you, and I know that I'll be fine. But, it's all still a bit . . . overwhelming." He let loose a long breath. "Emily – she's trying to be strong. And Dan . . . I know he's scared and nothing I say seems to help."

In all my years as a surgeon, I'd never really considered what my patients or their relatives were going through. All I cared about – all I needed to care about – was making sure the surgery was concluded successfully, which for me had generally been relatively simple. So, I had little idea how to respond to Parsons' concerns.

"Oh, for goodness sakes," Parsons said. "The last thing either of us needs is for me to get all maudlin." He stood up. "And besides, you need to get back to your surgery. Can't have the head of the PCT keeping a GP away from his sick patients."

I also rose to my feet, guilt wrapped uncomfortably around me. I'd spent almost my entire time in Parsons' home revealing my inadequacies. What I hadn't done was give him any moral support beyond spouting platitudes about his impending operation. In all the years we'd known each other, he'd always been there for me. The only thing he'd ever asked me to do was perform his endarterectomy and, by backing out of his surgery, I'd done the exact opposite.

This, I knew, was my opportunity to return the favor. Even now there had to be something I could do, something short of performing the operation, which might be at least remotely useful. I hadn't been there for Louisa; maybe I could do a mite better with Parsons.

"Would it be helpful," I asked tentatively, "if I were to come to hospital with you the day of the operation? I could . . . sit with Emily?" As I spoke, I tried to gauge Parsons' reaction. I'd done enough to make a mess of things. Perhaps my being there to remind them of that fact was the last thing he or Emily wanted.

Parsons' eyes seemed to light up. "Would you do that, Mart? I'll be okay, but Emily and Dan . . ."

"Of course," I said quickly.

I could almost see a layer of stress leave Parsons' body and his eyes seemed to mist yet again as he grasped my hand. "Thank you."

I forced myself not to pull away from the contact. "Right. Then I'll see you a week from Thursday."

As I took my leave, I wondered who was more apprehensive about the surgery. Parsons, who would undergo operation? Or I, who would sit in the waiting room with Emily and Dan while another surgeon operated on my friend?


	11. Chapter 11

"Don't take this the wrong way, Martin, but I still wish you were doing my surgery." Parsons gazed at me through the rails of his hospital bed. Without the benefit glasses or contacts, I wondered how clearly he saw my face.

I knew the statement was meant as a compliment and that Parsons was merely assuring me that I remained his preferred surgeon. Still, it hurt more than it should have. "Leahy is excellent," I replied.

"I know. You wouldn't have recommended him otherwise, right?" Parsons gave me a weak smile.

"Right."

I sat at Parsons' bedside in one of the uncomfortable visitor chairs, his wife Emily next to me. Their son, having already given pre-surgery well wishes to his father, was in the waiting room with Louisa.

So much had happened in the past two weeks. I'd had to perform the emergency hernia repair on Louisa's mother. There'd been no other option and, as Aunt Ruth had predicted, I could successfully operate when I needed to, in a crisis situation. It had been important to prove that to the village, to Louisa, and most importantly, to myself. It didn't change my situation - I still wasn't prepared to operate on Parsons - but my success with Eleanor had restored at least some of my confidence.

Not long after, Louisa's mother had left Portwenn, that nutcase Mrs. Tishell had turned psychotic and kidnapped James Henry, and I'd told Louisa that I loved her. We were still coming to terms with our relationship but I was happier than I'd been . . . maybe forever. Just as I hadn't shared the news of our breakup with Parsons, I also hadn't told him about the events of the past days. There'd be plenty of time for that once he was through the surgery.

It was hard for me not to view Parsons with a clinical eye. He seemed a bit pale, although the thin white hospital gown and overhead neon lights didn't do much for anyone's complexion. A quick glance at the bedside heart monitor confirmed what I'd suspected – mild tachycardia. The pre-op sedative would take care of that.

Like most patients awaiting imminent surgery, Parsons was doing his best to remain brave in the face of obvious apprehension. He'd been chatty with the hospital staff, all of whom clearly knew and liked him, and had joked with his family about the skimpiness of the hospital gown and how the mandated fasting was a great start to a diet. I saw the act for what it was because I'd seen it so many times before.

Emily was bearing up surprisingly well. She'd been upbeat when Dan was in the room and remained positive as nurses went about their preparations. She was a strong woman, I decided, not unlike Louisa.

Parsons was scheduled to go into theatre in less than an hour. Leahy had come by a few minutes ago to go over the procedure as well as the potential risks of surgery. The list of what could go wrong was long and ominous. Even though most of those complications were unlikely with a healthy patient in the hands of a skilled surgeon, I could see Emily flinch a bit as she listened to the recitation. Nonetheless, I had to admit that Leahy projected an aura of confidence and assurance that seemed to calm both the patient and his wife.

After Leahy had finished, I'd had a quick word with him in the corridor. He'd agreed that this was a routine procedure and, given Parsons' overall health, the prognosis was excellent.

"Don't worry, Martin," he'd said upon taking his leave. "I know he's special. I'll take good care of him."

Shortly thereafter, pre-op activities began to pick up. A registrar came in to insert the arterial line, which would be used to monitor blood pressure during surgery. The procedure was usually performed after the patient was in theatre, but Parsons had insisted it be done before he went in. When the registrar asked Emily to wait outside during the insertion, I also started to take my leave.

"Mart?" Parsons' voice called me back. "I'd like you to stay."

He crooked his finger at me and I moved closer to the bed. "Make sure they do things right," Parsons said in a soft voice. "But please don't say anything to piss them off," he finished with a wink.

The young anesthetist covered Parsons' lower left arm with surgical drape and laid out her instruments. "Small stick," she said.

Not exactly, I thought; arterial punctures could be somewhat painful. As she inserted the catheter, Parsons flinched – more than he should have, I noted automatically. A glance at the site of the insertion showed far too much blood pooling on the surface of his skin. She'd obviously missed the artery.

"Blast," the registrar said, shaking her head in frustration. "Sorry, Dr. Parsons."

"It's all right," Parsons replied though gritted teeth.

"No it's not," I said, forcing myself not to look away even though the contrast of the crimson blood on Parsons' pale arm was turning my stomach. I took several deep breaths to sublimate my queasiness. "Insertion of an arterial line is a simple procedure. If you can't do it properly, find someone who can."

"Martin," Parsons cautioned me.

"Christopher," I mimicked in the same tone.

The registrar gave me a nasty look and I rather wished I were the surgical consultant on the case so that I could give her a proper dressing down.

Thankfully for Parsons, and probably for me as well, her second attempt at inserting the line was successful. Almost immediately, a nurse came in to add antibiotics to the IV line and insert a Foley catheter. There would be no general anesthesia; Leahy had informed me he would go with a local, which is what I would have chosen.

It was strange watching all of the pre-op activities, most of which I hadn't seen since my days as a senior house officer. Like Leahy was doing now, I'd always waited patiently in theatre, assuming everything would be done properly so that a fully-prepped patient was laid out on the table, ready for me to exercise my surgical skill. I didn't stop to consider all that needed to happen and the effects of the activity on the patient and his relatives.

Emily had come back into the room just as the nurse was administering the sedative, which meant that Parsons would shortly become incoherent from the effects of the drug.

I stood out of the way as he and Emily spoke to each other in hushed tones, her hand grasping his. She kissed him lightly on the cheek and lips and I heard each of them say, "I love you" more than once. When they'd finished, she stepped away from the bed, sucking in a few deep breaths. Outwardly, she seemed at peace, but I could read the tension in the lines of her face and in the way her hands balled into tight fists.

Parsons turned toward me, his eyes trying hard to focus. "Mart, thank you for everything."

"I haven't done anything." In fact, I was standing at his bedrail when by all rights I should be the one in the operating theatre. Even though I'd come to terms with the current state of my professional status, the moment starkly reminded me of the cruel hand fate had dealt.

"Yes, you have. Someday I hope you'll realize just how much." Once again he waved me toward him. "Come here."

I took a step toward the head of the bed.

"Closer."

I leaned in until my head was only inches from his mouth.

"If anything happens," he whispered, "take care of Emily and Dan."

"There'll be no need. It's a routine—"

"I know. A routine procedure."

"Chris, you'll be fine."

"But, if I'm not—"

"Yes, I'll take care of your family."

Whether it was my reassurances or the sedative finally kicking in, Parsons' eyes slowly closed.

* * *

><p>Medical Glossary<p>

Arterial line – basically an IV placed into an artery rather than a vein. In this case, it's used to measure blood pressure during surgery.

Foley catheter – used to drain urine

Heparin – a blood thinner

Senior house officer – a junior doctor; the UK equivalent of a US junior resident

Note: In the US, vascular surgeons typcially use general anesthesia for carotid endarterectomy. However, based on my research, in the UK, local anesthesia is preferred.


	12. Chapter 12

Once Parsons had been wheeled out of the ward on his journey to theatre, I was left alone in his now-empty hospital room with Emily. I'd first met her during medical school, through Parsons of course. She'd been a social worker in the hospital where he and I had later been house officers. Her job included arranging home care, physical therapy, occupational therapy, as well as general hand-holding of patients and relatives during difficult times.

She was often forced to deal with the lonely and downtrodden that made their way through our wards. Parsons and I fixed the patients' bodies; she fixed their lives. It was all a bit esoteric to me, but the patients and their families seemed to find her work useful. As we'd talked about during the night Louisa and I had been in their home for the aborted dinner party, she'd continued her job upon their move to Truro until long after their son had been born.

From a personality standpoint, Emily was more vivacious and outgoing than her husband, if such a thing were possible. But not today. No sooner had the stretcher rolled out of the room, then she burst into tears.

Emotional displays always flummoxed me and for a long minute I stood there, watching her, not sure what to do.

"I promised myself . . . I wouldn't cry," she sniffed, "in front of him or Dan."

Obviously, she considered it acceptable to do so in front of me. I stepped over to her and stiffly put my arm around her shoulders, feeling her body shuddering beneath me. With my free hand, I grabbed a tissue from the bedside table and handed it to her.

"I'm so scared," she said.

"He'll be all right," I soothed. "It's a straightforward procedure."

"He's never had surgery before, you know."

"Yes." I recalled this from the medical history I'd taken.

"I know he wishes you could do it . . . that you were still . . . he trusts you so much."

Once again, I cursed my weakness. Were it not for my hellish blood thing, I'd be performing the surgery and able to control the situation instead of try to reassure Emily that another surgeon would save her husband.

"I'm . . . sorry." It was all I could say.

Emily blew her nose. "No, I'm the one who should be sorry – for being weak and especially for making you feel guilty when all you've done is help us." She stood up straight, squaring her shoulders and I dropped my hand.

"I need to go sit with Dan," she said. "I know he's worried. He worships his dad."

"Shall I come with you?" The thought of sitting in the waiting room was this side of appalling. But I _had_ promised Chris that I'd take care of Emily and this appeared to be the first step in honoring that promise.

She found a smile. "I'd like that very much."

We located Parsons' son sitting next to Louisa in the surgical waiting room. The boy was lanky and, with an angular face, fiery red hair and a few freckles, more closely resembled his mother than his father.

Louisa and the boy each held a handful of playing cards, with a larger deck stacked on the table in front of them; Louisa had apparently been trying to distract Dan's attention with the game. James had been left in the care of Aunt Ruth and Morwenna, and Louisa would return home immediately after Parsons was safely out of surgery.

As we stepped into the room, Dan abruptly tossed the deck onto the floor, cards flying all about. "I don't want to play cards! I want to know what's going on with my dad. My parents won't tell me anything. They think I'm a baby."

"Quiet," I said sharply. There were others in the waiting room, all clearly distressed about their own loved ones currently in surgery, and the last thing they needed was an unruly child causing a commotion.

Louisa tried putting an arm around the boy's shoulders. "I'm sure they don't think you're a baby."

The boy shrugged her off and ignored my admonition. "It must be really bad. He's going to die, isn't he? That's why no one will tell me anything."

Louisa shot Emily and me a look of helplessness, causing me to frown. She was always excellent with children; if she'd been unable to console Dan, the situation must indeed be serious.

Beside me, Emily started forward. I caught her arm and said softly. "Let me." I locked eyes with Louisa. "Why don't you and Emily . . . get some coffee or something like that . . . while I have a word with Dan?"

Louisa's expression morphed into one of unexpected gratitude. Taking my cue, she stood up and moved to the door, Emily in trail. "Come on, let's get some tea."

I motioned the boy to follow me to a far corner, away from the others in the room. He plopped himself into one of the vinyl chairs with a huge sigh. I pulled over a chair so that I was directly across from him and met his eyes.

"All right, Dan. What is it that you want to know about your father's medical condition?"

"Like you'll tell me the truth," he responded defiantly.

"Of course I will." Why would he think I'd lie to him? As Peter Cronk had once said to me, "You always tell the truth." Sometimes to a fault. Now I said to Dan, "Tell me what has you so upset."

"I don't understand what's wrong. Dad said it was something about his neck and it made him dizzy and that you were the one who found it and –"

I held up a hand. "Stop."

The boy closed his mouth and stared at me. At age eleven, he was old enough to comprehend the basic medical issues, even though he might not understand all of the details. Explaining things to him had to be better than watching him throwing a temper tantrum for lack of information.

I started slowly. "Your father has a blockage in one of the arteries of his neck. Do you know what an artery is?"

The boy scrunched up his nose. "Not exactly."

"Arteries are vessels that carry blood from the heart to other organs of the body. One of those important organs is the brain. The arteries that supply the brain are called the carotid arteries and are located in the neck. Right here." I pressed the fingers of my right hand against my own carotid. "There's one on either side."

Dan tried to mimic my movement and I reached out to help him find the proper spot on his own neck.

"I can feel it," he said, eye wide.

"Yes, you can." I blew out a breath; at least the child was listening. "An artery is like a straw. When the artery is clear, blood flows through it easily, like lemonade through the straw. However, in some people, the artery becomes clogged —much like when something gets stuck in a straw."

"Yeah, I get it."

His eyes were riveted on mine and he seemed to be paying close attention to my explanation. I could only hope I was making things simply enough for him to comprehend. And, as I tried to make sense of things for Dan, I couldn't help but think about the future, when it would be my own son who would be full of questions. My father had generally been dismissive of my intellectual curiosity; I vowed to do better.

"When the carotid artery is blocked," I continued, "the flow of blood to the brain can slow down or even stop altogether for a very short time. That can cause you to lose feeling in your arms and legs, to be dizzy or have trouble speaking."

He nodded. "That's what happened to my dad the night you came for supper."

"That's right. But it can easily be fixed with surgery."

"What do they do?"

"The surgeon cuts a small hole in your father's neck over the artery with the blockage."

The boy's eyes widened. "Wow, I bet there's lots of blood. Does it just splatter all over everyone?" he asked gleefully, clearly imagining a gusher.

I frowned in disapproval. "Well that wouldn't be too good for your dad, to lose all that blood, would it?"

Gulp. "No. Mr. Leahy wouldn't let that happen, would he?" he asked anxiously.

"No, he won't. Mr. Leahy cuts open the artery—"

It was Dan's turn to frown. "It's so small. How does he see it?"

"He uses loupes – basically eyeglasses with a microscope attached."

"Cool."

It was, actually. "He then places clamps – sort of like pliers – to stop the blood flow while he works. It's like pinching off the ends of the straw."

Dan's eyes narrowed. "But then how does the blood get to his brain?"

It was an excellent question. "The surgeon inserts a tube that allows the blood to flow around the blockage." It was the simplest way to explain a shunt.

Another nod. "Oh."

"The surgeon cleans out the blockage, stitches the artery closed, and removes the clamps. Finally, he sews up the hole in the neck." The explanation wasn't technically precise but was good enough for an eleven-year-old child.

"Will he have a big scar?" Again the boy's eyes seemed to widen in delight.

"There'll be a scar about this long." I showed him the seven-centimeter distance with my fingers.

"Wow!"

"It will fade in a few months."

"Oh," he said. "So my dad's going to be okay?"

"It's a routine procedure. Surgeons like Mr. Leahy perform this surgery almost every day. They're very good at it."

"But something could go wrong," he insisted.

"It's highly unlikely."

"Then why's my mom so worried?"

"Relatives often worry even when there's no cause." When the boy gave me an odd look, I added, "Your mother loves your father very much. It's . . . difficult to entrust the life of someone you love to a stranger, even if he happens to be a very good surgeon."

"Are you worried?" The boy's eyes searched mine in the way that only children could seek out the truth.

"No."

"Really?"

"No, I'm not worried. Your father will be fine."

"My dad says you used to be a surgeon like Mr. Leahy."

"Yes, I did."

He gave me a lopsided smile. "I bet you were a good surgeon."

"Yes, I was."

"So why aren't you operating on my dad?"

"Your father and I are friends and it's not a good idea to operate on your friends." The statement was true, even if it wasn't exactly the reason I wasn't performing Parsons' surgery.

"Why not?"

There were reasons I didn't get on with children, and this was one of them – they asked too many questions. "It's just not a good idea."

He seemed to accept this explanation and settled back into his chair, apparently content for the moment. To my consternation, I now found myself worrying. Not because I lacked confidence in Leahy's skills but, because if something did go wrong, I had no idea how I'd ever explain it to the boy.

Emily stepped in and took a seat next to her son. I in turn walked over to where Louisa was standing at the door of the waiting room.

"That was lovely, Martin."

I shrugged off the compliment. "I simply explained what was—"

"You calmed him down. You took a scared young boy and reassured him that his dad would be all right. It was quite wonderful."

I decided to accept the compliment. "Thank you."


	13. Chapter 13

As Louisa slipped her hand into mine and I squeezed it gently, I decided that surgical waiting rooms could indeed be frightening places. A telly hung from the ceiling, airing the BBC at a volume one could hear only if paying close attention. Dozens of antiquated magazines to which no one would voluntarily subscribe, or even read, littered the tables. Some relatives tried to read books or even work on a computer. It was easy to see that the distractions weren't working; to a person, they were nervous, anxious, and scared.

Each time the waiting room door would swing open, a dozen heads would anxiously pop up to see if their surgeon was the one approaching, if it was their turn to learn the fate of a loved one. And, those for whom news was not yet forthcoming would return to their eerie vigil.

Even Louisa wasn't immune. She'd brought with her several magazines, but I noticed that she mostly flipped through them and had been staring at the same page for the past twenty minutes.

I'd been through the experience many times, but always from the other side. I'd been the one delivering the news, not awaiting it. I now realized that, as many times as I'd done it – literally thousands – I'd never thought twice about what the relatives were going through. I'd simply relayed the facts and the outcome, which generally was favorable. I endured their appreciation – expressed with words, hugs and even the occasional kiss – and went on my way. Often it was the last, or even the only, time I'd ever see them, which was fine with me.

"How long does the surgery take?" Louisa asked, looking away from her magazine.

"Ninety minutes, more or less."

"How long has Chris been in theatre?"

I recognized her questions for what they were – a way of redirecting her nervous energy.

I glanced at my watch. "Forty-five minutes."

She sighed. "Halfway done, then."

I started to correct her, to explain that the surgery might well be over in only an hour or, if the surgeon ran into unexpected complications, could take closer to two. And that the chief surgeon usually let one of the registrars open and close, meaning that he was free to talk to the relatives even before surgery was fully concluded.

I closed my mouth before a word came out. None of it really mattered.

The feel of Louisa's hand resting firmly in mine took me back to the previous night when we'd made love in our small bed, the first time since that short period after our engagement. In the months since our son had been conceived – when Louisa was in London and then even after she'd returned, I'd convinced myself that I could easily spend the rest of my life without her, without her touch, her scent, or the feel of her body intertwined with mine.

Last night had changed all that. We'd started slowly, cuddling and holding each other as we had so many times since we'd been back together. What we hadn't done on those other nights was actually have intercourse. It had been just over two months since James was born and I worried about causing Louisa any discomfort. Of course, in the midst of our foreplay, I'd had to question her about it.

She'd propped herself on one elbow. "Martin," she'd said, more than a little frustration in her tone. "Stop being my doctor! I'm fine; I'm enjoying this. If something hurts, I'll tell you."

So, I'd done my best to turn off my medical instincts and instead focus my energy on giving her pleasure. And seeing her pleased only heightened my own pleasure and desire. Unlike those first few times when our lovemaking was fresh and frantic, last night we'd proceeded gradually, enjoying the experience of discovering each other's bodies once again after so many months apart. Whereas the first few times, it was mostly lust, last night, it had been intimacy. And, when James Henry had awakened us an hour later, somehow it didn't even matter.

As I sat here in the surgical waiting room on the morning after, feeling the security of Louisa's touch and smiling inwardly at the memory of a few hours before, I wondered how I'd ever managed to convince myself I could live without her. After these weeks together – and then the passion of last night – I couldn't imagine _not_ being with Louisa.

Even as those thoughts crossed my mind, I mentally kicked myself. What hell was I doing daydreaming about making love to Louisa while Parsons was lying on the operating table as Nigel Leahy scooped plaque out of his neck? And while his wife, only a few seats away, worried about whether she would ever again spend even one more night in bed with her husband.

As the morning wore on, I found consulting my mental clock, walking through the procedure in my mind and hoping that everything was going according to plan. The greatest risk was a CVA on the table, which was why it was so critical for the surgeon and anesthetist to monitor Parsons' pressure throughout the procedure. His history of hypertension would be a complicating factor.

Louisa had gone for coffee for herself and Emily and lemonade for Dan. I deferred – even as a surgeon I'd spurned hospital coffee that, in my experience, was uniformly cold and tasteless.

A glance at my watch showed that nearly ninety minutes had passed and I found myself getting edgy. Using a local rather than a general anesthetic should have shortened the time on the table, and the fact that Leahy had yet to appear wasn't a good sign. I forced myself not to fidget in my seat; any sign of nervousness on my part would only add to Emily's and Louisa's concerns.

Just when I was about to visit to the surgical information desk to find out what the hell was taking so long, I saw Leahy stride through the door, still dressed in his surgical scrubs – absent cap and mask. He cut a striking presence, standing more than two inches taller than my own considerable height. With bushy almost black hair that sported only a touch of gray, deep brown eyes and a square jaw, one could easily mistake him for an actor or even a fashion model.

My focus, however, was on his demeanor. I knew how a surgeon felt, and looked, when surgery hadn't gone well. Thankfully, I didn't detect a hint of consternation in Leahy and allowed myself an inward sigh. I also knew that, if the news were bad, Leahy would never have delivered it in the presence of Dan.

He covered the distance to us in a few strides as we rose to our feet. Louisa's hand grabbed mine, her nails digging into my palm.

"Mrs. Parsons," Leahy said formally, focusing his attention on Emily.

"Yes," she answered in a shaky voice.

His features turned into a smile. "Everything went very well."

Emily sighed heavily. "Oh, thank God."

Tension unexpectedly fled my own body.

"Chris is in Recovery now and will be moved to the high dependency unit within the hour," Leahy continued. "You can see him once he's there. Why don't you get a bite to eat? It'll be another hour or so before he's moved."

She reached for his hand. "Thank you."

Leahy's smile broadened. "Of course."

As Emily hugged her son, I trailed Leahy into the corridor, anxious to ask a few technical questions about the procedure. We discussed control of Parsons' blood pressure, the shunt he'd chosen, the amount of calcification, and likely post-operative course.

"I know it took a bit long," he concluded, "but I wanted to do the closing myself."

I was unexpectedly impressed. Leahy probably hadn't opened or closed in years; for him to do it for Parsons was truly going the extra mile. "I appreciate that," I replied.

"Well, everything looks good, so I'm planning to head back to London this evening," Leahy said. "Parsons should be discharged tomorrow. Dinwiddie will be his surgeon of record, but I'd like you to check him as well. I hate to say this but you've forgotten more about endarterectomy than most of the physicians in this hospital will ever know. Your BMJ article on blocked carotids is still required reading for my registrars."

I tried to hide my smile at the compliment. "Of course."

"And I suggested he follow up with you as his GP, at least initially. For the same reasons."

"Thank you again, Nigel."

"Happy to help. And I mean that." He started to turn away then stopped and looked me in the eyes. "And, Martin?"

"Yes?"

"You were a terrific surgeon and, from what Parsons tells me, you may be an even better GP. Whatever you decide to do going forward . . . I wish you the best. I really do."

I simply nodded and watched as he walked toward the surgical changing room. He was returning to his chosen path and I . . . at the moment, I had no idea where my future lay.

* * *

><p>Glossary<p>

BMJ – British Medical Journal; the JAMA (Journal of the American Medical Association) of the UK


	14. Chapter 14

Most patients seeing me for post-surgical follow up were required to visit my surgery if they were at all physically able. Chris Parsons wasn't most patients, and it made no sense to have Emily make the long drive only days after her husband had returned home from hospital.

For this reason I was spending my morning making a house call to check on his progress. Emily greeted me at the door with haggard features and a strained smile.

"I'm so glad to see you, Martin."

I frowned slightly. "Is something wrong?"

"No," she quickly reassured me. "It's just that . . . well, Chris hasn't seen a doctor since he came home from hospital and I'll feel better once you've checked him over. I'm just a worrier," she added.

"Hmm," I grunted trying to decipher the comment as I followed her into the living room. Parsons sat in overstuffed chair with his feet propped up on an ottoman. The fact he was resting was a good sign. He wore a loose T-shirt, probably because it was one garment that didn't irritate his wound.

"Mart," he greeted me, careful not to twist his neck too far or too quickly. "About time you showed up to take out these damn sutures; I was ready to do it myself."

I rolled my eyes at the comment as I strode across the room and set my bag on the floor next to his chair. Facial and neck sutures needed to stay in for five days, as Parsons well knew. He looked good for being less than a week out of surgery, although still a bit pale. There was significant edema and a large hematoma on the left side of his neck, both of which were to be expected at this stage.

"Let me see." I snapped on a pair of gloves, pulled up a chair and, carefully tilting Parsons' head to the side, scrutinized the wound closely, gently pressing along its edges.

"It's looks so horrible," Emily said from behind me. "Is it infected?"

To a layman, it probably did look somewhat gruesome but, to my experienced eye, it was healing quite nicely. Leahy had done excellent work. I glanced around at Emily. "It's normal for there to be swelling and bruising in the first few weeks after surgery. There's no sign of infection."

"Told you," Parsons said pointedly to his wife.

"I wanted confirmation from the expert," she replied, giving me an appreciative look.

"Any numbness?" I asked, as I set about removing the sutures. The carotid lay beside sensitive facial nerves and even the best surgeon could leave some impairment. Thankfully, it was almost always temporary.

He started to shrug and nod. "A little."

"Keep your head still," I snapped.

"Sorry," he replied with an apologetic grimace.

"As you know, it's common to experience some numbness. It should resolve within a month or two." Using forceps, I picked up the knot of the next suture and then cut it with surgical scissors before pulling it from the skin.

"Yeah. No complaints here."

"Are you still having pain?" I asked as I worked.

"Only if I move my head too quickly."

"Then don't move your head too quickly."

"Right."

"I'm sure Leahy told you that some pain and stiffness is to be expected for at least a fortnight."

"Yes, he did."

"Is the paracetamol adequate for analgesia or should I prescribe something stronger?"

"It's fine."

"And you're continuing aspirin therapy?" Aspirin served as a mild blood thinner and would be necessary for months, and perhaps forever.

"One a day."

Having removed the last of the sutures, I glanced away from my work. "Any trouble sleeping?"

"Not really," Parsons replied, a touch of annoyance creeping into his tone.

I ignored it. My questions were important in terms of his post-operative recovery. "And that means?"

He sighed. "I'm fine, Mart. Really. Thankful to be alive."

I let that go, put aside my instruments and retrieved the stethoscope from my bag. "Lift up your shirt."

"Why?"

"Why do you think?" I replied smartly then, in a slightly softer tone, added, "I need to make sure you aren't developing a respiratory infection." It was a not uncommon post-operative complication of endarterectomy. I had Parsons breathe in and out until I was satisfied his chest and lungs were clear.

"So," he asked, as I packed up my bag and stood up, "can I go back to work tomorrow?"

"Of course you can't! In case you hadn't noticed, you've just had major surgery. You need to rest."

"Oh, come on, Mart. I have a sedentary job. I'll get as much rest in the office as I will here."

"Are you stupid? No driving and no working for at least three weeks."

Parsons waved him arm in an arc. "I'll go stir crazy sitting around here all day, not to mention I'll drive Emily nuts."

"I don't care."

"Martin, you . . ." He started to shake his head, then thought better of it and rolled his eyes. "Oh, never mind."

"Hmmf," I replied, satisfied with my victory.

Emily approached with a tray of water and tea. "Would you like something to drink?"

She must have left the room while I was attending to her husband. I accepted the water and took a seat in the chair across from Parsons, who allowed Emily to serve him a cup of tea.

"So," he asked, "have you come to any decisions about whether to go to London or stay in Portwenn or . . . do something else?"

"I don't know." I was comfortable talking about post-operative complications; I wasn't all that interested in chatting about my future, even with Parsons. "I need to discuss it with Louisa."

Parsons smiled. "Well, that's a good sign."

My eyebrows lifted even as I frowned a bit. "What?"

"That you're actually consulting her about your decision."

"Yes, well . . . it's not only about where we live. I also have to work there."

Although I'd promised Louisa that I'd stay in Portwenn because Louisa was here, we hadn't actually had the opportunity to sit down and discuss whether that was what we wanted to do. It was odd thinking about what she might want; what was best for the both of us - actually the three of us - rather than solely what was best for me. I'd made that mistake in my aborted attempt to flee to London. As I'd come to realize, I'd been terribly wrong to think that I was better off without Louisa or that I could even be satisfied without her. And that, strange as this new approach was to me, it also made me happier than I ever thought I could be.

Parsons sipped his tea and looked at me over the rim of his cup. "Based on our prior conversation, I assume you're thinking of a GP post."

I sighed. "Yes, I suppose so." I said, as the chimes of his grandfather clock punctuated the finality of my statement. If Aunt Ruth's theory was correct, what choice did I have?

His eyes seemed to smile. "You make it sound like purgatory."

"It's what I must do, not what I choose to do." The events of the past week had brought home the sobering fact that, despite my successful hernia repair on Louisa's mother, I would be forever relegated to the tedium and mediocrity of general practice.

"Don't tell me you never find it rewarding to be a GP." Parsons' tone remained light and I wondered if he understood the depth of my anxiety.

I stood up and walked across the room. "If you call treating URIs, UTIs, arthritis, and migraines rewarding. Oh, and then there's the occasional exciting case of acute bronchitis to spice up my day."

Parsons didn't rise to the bait. "You have to admit that _my_ case was a bit out of the ordinary. Your diagnosis was spot on and in record time. There probably isn't a GP this side of London who could have done what you did. You may well have saved my life."

"Surgery performed by someone else saved your life," I responded bitterly. "I sat in the damn waiting room like some grandmother while Leahy cured you." I stood up. "Blast it, Chris! I spent much of my life training to be a surgeon. And now that I can no longer do it, I'm just supposed to sit back and accept my fate with a smile? No thank you!"

"Mart, if you don't want me to twist my neck trying to follow you around the room, then please sit down."

It was a fair request and I felt a bit chagrined for my impulsiveness. "Chris," I said, resuming my seat. "I'm meant to fix things – people. It's why I became a surgeon."

"I know that," he replied patiently.

"And both of us know that I don't exactly have the . . . temperament to be a GP."

"Your patients in Portwenn have come to accept you as you are."

"They don't exactly like me."

"They don't need to like you. They _liked_ Dibbs and we both know how that turned out."

I remained silent.

"Look Mart, I'm not going to try to convince you that you can save people just as well working as a GP or debate whether or not you should try to continue your career as a surgeon. I'll only say that we often end up where we're meant to be."

"How prosaic," I replied with disgust. How could he know where I was meant to be or what I was meant to do? I knew I was meant to be a surgeon and God only knew why fate had taken that from me.

"Right. Well, for purely selfish reasons, I hope you stay here, in Cornwall at least. You _do_ know there are Cornish towns and villages other than Portwenn if you change your mind about staying here," he added with a smile.

"Of course I do."

"And I hope that you'll remain a GP," he added. "The NHS and the PCT need good men like you."

I wondered if Parsons were being honest or simply trying to convince me to stay so that he didn't have to find my replacement, then quickly banished that thought. Parsons had in fact done everything he could to get me the surgical post at Imperial. And yet, for some reason, he still believed I was better suited to my current role as a GP.

"At this point, I'm not sure what I want."

"I know you don't. You have time to sort it out, and I'm sure you and Louisa will make the right decision. I just want you to consider all of your options."

All my options? At the moment, all of my options seemed like no option at all.

* * *

><p>Glossary<p>

Analgesia – pain relief

Edema – swelling

Forceps – hinged instrument used for holding onto things, such as sutures

Hematoma – bruise

URI – upper respiratory infection such as the common cold

UTI – urinary tract infection


	15. Chapter 15

One advantage of my drive from Parsons' home back to Portwenn was that it allowed me to think without simultaneously having to carry on a conversation.

Louisa had never answered my question about whether she would be – or even could be – happy in London. I was quite certain I knew the answer. Twice she'd lived there – once in college and once after our non-wedding – and both times she'd returned to Portwenn. Why should her third time be a charm, as the adage went? Why had I thought that, just because I'd wanted to live and work in London, such a move would make her happy?

When I'd packed my things for London, I'd convinced myself that I could easily pick up my life exactly where I'd left it. I didn't need Portwenn or Louisa. All I needed was my surgical practice and a small flat in a convenient location.

And, when I started to drive away from the village on the long trip to London, I promised myself that I'd never look back, at least not fondly. Portwenn was now my past; London was my future.

And yet, I couldn't even get out of town. No, I'd had to stop my car when that silly teacher had collapsed from methanol poisoning. And that had led me to the moors and Louisa and the pub and the birth of my son and . . . doubts.

I told myself that, when the new GP took over, I wouldn't interfere. She was the doctor; she, not I, was now responsible for the nearly one thousand lives in the village and its surroundings. And yet, I found myself unable to stand by as Dr. Dibbs doled out her doses of incompetence. I'd cared for these people for the past several years and I was damned if I'd let someone undo all of the good work I'd done in that time. For reasons I couldn't quite explain, I did care about these people – at least about their health – and, as I was coming to realize, I always would. And hated myself for it.

There was little doubt that remaining in Portwenn would make Louisa happy, but would it make me happy? After all, I openly derided the village and its denizens at virtually every opportunity. As I was wont to say, I was here to provide competent medical care, not to make friends and, in that I had fully succeeded. There was no doubt that the standard of GP care in the village had significantly increased under my tenure. Still, only days ago I'd told Louisa that I would stay in Portwenn for her, because she and James were here. And I wouldn't go back on that promise. If she wanted to stay in Portwenn, then by God I'd somehow manage.

When I returned to the surgery an hour later, I found Louisa in the kitchen, chopping vegetables. James Henry was sitting contentedly in his carrier on the counter watching her. I stepped over to him and, as was my wont, touched the back of my hand to his forehead, finding it soft and pleasantly cool.

"How's Chris?" she asked, looking up at me.

I shook my head. "Ornery as ever."

"Martin!" She gave me an exasperated look.

"Medically, he's fine. Doing very well, actually."

"I'm so glad." She scooped a handful of carrots into a bowl. "I'm making a roast for dinner."

"Meat?"

"Yes, Martin. Meat. It's only one night."

"Right." It probably wouldn't kill me to eat meat on occasion. After all, I'd forced fish on Louisa almost every night since we'd been together. "By the way, Chris asked what we plan to do. Where I want to work."

She glanced up from her chopping. "What did you tell him?"

"I told him I needed to talk it over with you."

"Really?" The surprise in her voice was obvious – and somewhat disconcerting, as I once again realized how little I'd consulted her over the years.

"Yes." I retrieved plates and silverware from the cupboard and started setting the table. "Louisa, you don't really want to go to London, do you?"

"I said I'd go with you, Martin, and I meant it."

"But you wouldn't be happy there . . . and neither would I."

Her eyes widened. "What do you mean?"

It was time to be honest. If I'd meant all of the things I'd said to Louisa at the castle, now was the time to start proving it. "I wanted to go to London because . . . because it wasn't _here_. And because I thought I could recapture what I once had, a time when I thought I was truly happy."

Louisa put down the knife and stared at me. "Martin?"

I placed the last of the silverware and dropped into a chair. "London may have made me happy then; I'm not sure. But I know it won't make me happy now."

"But I thought . . . you're sure?"

"Yes," I said. And I was. Whatever impulse had driven me to return to London was now gone. There was nothing for me there. No friends, no family, and now not even a surgical career. There was only an empty, bright white flat overlooking the stupid science museum.

She leaned against the counter. "So what do you . . . what do we . . . do?"

I sighed. "The GP position here is still open. Would you like me to stay here? In Portwenn?"

Her eyes seemed to gaze right through me and for at least a full minute, she remained silent. "I don't know," she finally said, so softly that I almost didn't hear her.

This time it was my turn to look surprised. "But I thought . . ." I'd always assumed she wanted to stay here, living in the village where she grew up, socializing with her lifelong friends, teaching in the school she'd attended as a child. And thus that she'd want me to stay here as well.

"I've already given my notice at school—"

I waved off her objection. "Certainly they'd tear it up. They won't find a better head teacher."

"And there's Mrs. Tishell." It was almost as if Louisa hadn't heard my reply, or compliment. "Oh, I know it wasn't her fault, that she was ill," she continued. "But she kidnapped our baby! She wasn't some stranger. She's someone I'd known and you'd known for years. We trusted her. And she stole him. She could have killed him. . . my God, Martin, he could have died."

"Louisa—"

"No! Martin. Let me finish."

I closed my mouth.

"When she took James Henry away, she took away the innocence of Portwenn, at least for me. I can never look at her again, knowing what she did." She sniffed, clearly holding back tears. "And I'm not sure I can ever look at Portwenn the same way again either."

I stood up from the chair and walked toward her, reaching out a hand to brush a single tear from her cheek. "Oh, Louisa." I didn't know what to say. I'd been so busy bemoaning my own fate that I'd never stopped to think about Louisa's feelings . . . her struggles. I'd never stopped to consider what she might be going through. It was one of the many things I'd need to learn.

Louisa was still talking. "It seems there are as many bad memories as good ones. My dad stealing from everyone, my mum caring more about cooking with Bert than her own grandchild, Mr. Strain, Edith Montgomery. Maybe all this is telling me it's time for me to leave, time to move on. Time to get away from this wretched place and these wretched people . . ."

"Louisa."

"Yes, Martin."

I gave her the tiniest hint of a smile. "Can I speak now?"

"Of course, Martin."

"This is your home and will always be your home. What that nitwit Mrs. Tishell did doesn't change anything. Don't let her horrid psychosis ruin the precious woman that you are."

Holding her shoulders, I turned her body until her back was pressed against my chest. I let my chin rest on her shoulder and gave her a brief kiss on the cheek.

"That's lovely, Martin. Really it is. But sometimes you have to leave your home. Like the bird leaving the nest." She sniffed back a few tears. "Besides," she added with a forced laugh, "you hate it here."

"No I don't," I replied automatically.

"You said so at the castle."

"I didn't mean it, exactly."

She twisted around to face me. "Then what did you mean?"

"I meant that I would go where I need to go and do what I need to do, as long as I can be with you and James Henry."

She pushed away from me and walked over to the baby, gently stroking his head. "And James Henry and I will go wherever you need to go. We'll be all right, as long as we're a family."

I reached out and took her head in my hands, staring into her gorgeous eyes. "I do love you." Our lips touched and, when we finally parted, I looked over to find James Henry staring at us with what I would have sworn was an expression of bemusement.

"So where shall we go?" she asked.

I shrugged. "Let's leave it to Chris Parsons."

"Really?"

"Why not? He needs something to do while he's recovering. Let him find me a practice."

She gave me an odd look. "You're willing to go wherever he sends us?"

"Well, we'd have to agree, of course."

"So we'll stay in Cornwall then?"

I shrugged. "I'd imagine so. I'm quite sure he'll try to keep me in the PCT."

"That's not so bad is it?"

"I suppose not."

"What if he thinks we should stay here . . . in Portwenn?"

"Then it's up to you."

"You really mean that?"

I swallowed hard. "Yes." I could do it. I would do it. I'd lived and worked in Portwenn for several years now; I suppose I could do it for the . . . for the rest of my life, God help me.

"And if he thinks . . . if we want to move on? Start over somewhere else. Would that be alright?"

"If that's what you want . . ." While daunting, a change of scenery might be exactly what we needed, both of us. And I could start over. It would be difficult but I could do it. And, this time Louisa would be by my side. A new village, new surgery, new patients, new school, new home . . . it might not be so bad.

"It also has to be what you want, Martin."

"I'll be alright." Or so I hoped. I was sure I wanted to be with Louisa and James Henry and could only hope that somehow everything else would work itself out. It had all seemed so simple at the castle; now that I had to make all of my promises a reality, the world suddenly had become much more complex. Still, this time Louisa would be by my side – we'd make the next decisions together.

"We'll be alright," I added, with a bit more confidence that I felt.

Louisa crossed the room and slipped her hand into mine. "You know what?"

I frowned wondering what I'd said wrong now. "What?"

Her eyes smiled. "I think this is the longest conversation we've ever had without arguing with each other."

"Yes, probably."

Her hand squeezed mine. "It's nice, very nice, Martin."

I almost laughed at that. Almost.

_~ The End ~_

* * *

><p>Author's Notes:<p>

I want to thank all of you who have taken the time and effort to comment on my little tale. Feedback is the one reward fanfic writers receive, and your encouragement and kind words mean more to me than you realize.

A final thanks to my beta jd517. A great beta not only corrects your grammar and typos but pushes you to improve your story and, in the process, hopefully become a better writer. She has done that and more!


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